Welcome to The Lee Health Volunteer Site

PLEASE ANSWER ALL QUESTIONS AND SUBMIT ONLY ONE APPLICATION TO ONE HOSPITAL. AFTER ORIENTATION, YOU MAY TRANSFER OR CHOOSE TO VOLUNTEER AT MULTIPLE LOCATIONS.

Adult Volunteer Application

ADULT VOLUNTEER APPLICATION
For Office Use Only
Badge #
(18 years of age or older)
Have you ever been a
How did you hear about our Volunteer Program?
Lee Health Employee or Volunteer?
At which Lee Health location do you prefer to volunteer?
Are you a Seasonal
or Year Round Resident?
If seasonal, which months available to volunteer
PERSONAL INFORMATION:
First Name
Middle Name
Last Name
Maiden Name/other last name known by:
Preferred first name for ID BADGE
DOB
Gender
Race/Ethnicity (optional)
Street Address Line 1
Street Address Line 2
Golisano Children's Hospital of SWFL (239) 343-5055
City
State
Zip/postal
Phone (Mobile)
Phone (Home)
E-mail
SEASONAL ADDRESS (if applicable):
Street Address
City
State
Zip/postal
IN CASE OF EMERGENCY, NOTIFY:
Contact Name
Relationship
Phone (Mobile)
Phone (Home)
Are you a Veteran?
If yes, what branch?
EDUCATION INFORMATION:
High School Graduate/GED
Are you currently enrolled in school?
College Degree Received
If currently enrolled in school, name of College/University
Year of Graduation
Major(s)
Number of service hours required for school (if any)
BACKGROUND INFORMATION:
Have you ever been convicted of, had adjudication withheld, or pled guilty or nolo contendre (no contest) to a criminal offense (misdemeanor or felony)? (We do criminal checks. Falsification or failure to disclose this or any other information on this application is grounds for termination. A conviction does not necessarily disqualify you from volunteer services).
Please select yes or no
Have you ever been refused bond?
If yes, please explain and include county and state:
WORK EXPERIENCE, SKILLS AND ACTIVITIES:
Are you retired?
Are you employed?
Current/Former Occupation
Skills
Volunteer Experience
Other Work/Volunteer Experience you would like to share
Why do you want to become a volunteer?
VOLUNTEER PREFERENCES:
Preferred Shift(s)
Preferred Day(s)
I am interested in:
Department(s) or area of preference (if any)
I certify I am at least 18 years of age and the above information is correct with no misrepresentations.
Date
Enter your full name as your online signature here:
If you need assistance or have any questions, please call the hospital of your choice:
Cape Coral Hospital (239) 424-2206
Golisano Children's Hospital of SWFL (239) 343-5055
Gulf Coast Medical Center (239) 343-0636
HealthPark Medical Center (239) 343-5055
Lee Memorial Hospital (239) 343-2388