Thank you for your interest in volunteering at Alegent Creighton Health hospitals. Please complete the online application, print the pdf application, or you may pick up a paper application at the hospital of your choice.

* required info
Hospital *
Application Date *
Age * 18 and over
14 - 17

PERSONAL INFORMATION

First Name *
Last Name *
Middle Initial
Email Address *
Street Address 1 *
Street Address 2
City *
State *
Zip *
Home Phone *
Cell Phone *

EDUCATION AND WORK EXPERIENCE

Current Employment Status Full time
Part time
Other
Business Address
Business Phone
May we contact you at work? Yes
No
Are you a student? * Yes
No
Previous Occupation (if retired)

SKILLS AND TALENTS

Retail Cashier
Good Customer Service Skills
Accomplished Musician
Computer Competency
Phone Work
Interacting with Patients
Good with Children
Organizational-Detail Work
Fundraising
Pastoral Care-EME
Certified Pet Therapist

DAYS AND TIMES MOST OFTEN AVAILABLE

Monday Morning
Afternoon
Evening
Tuesday Morning
Afternoon
Evening
Wednesday Morning
Afternoon
Evening
Thursday Morning
Afternoon
Evening
Friday Morning
Afternoon
Evening
Saturday Morning
Afternoon
Evening
Sunday Morning
Afternoon
Evening

PERSON TO NOTIFY IN CASE OF EMERGENCY

First Name *
Last Name *
Address *
City*
State*
Zip*
Home Phone *
Alternate Phone *
Email *
Relationship *

VOLUNTEER HISTORY

Have you volunteered at another organization? Yes
No
Organization Name
Phone
What were your Responsibilities?
Have you volunteered at another Alegent Hospital? Yes
No
If so where?

REFERENCES

REFERENCE 1

Name *
Phone *
Address *
City *
State *
Zip *
Relationship *

REFERENCE 2

Name *
Phone *
Address *
City *
State *
Zip *
Relationship *
Is there an agency school or anyone that will need documentation of your volunteer hours? Yes
No
If yes, what is the name of the organization?
Address
City
State
Zip