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College Volunteer Application
Thank you for your interest in the College Volunteer Program at Pomona Valley Hospital Medical Center (PVHMC). Please fill in this webform to submit your application request. Not all requests will be accepted.

 

College Volunteer Application

 

Emergency Contact Information
About You
Are you related to a PVHMC employee, physician, or Volunteer?
Have you previously applied for a postition at PVHMC?
What days will you be available to volunteer? (Check all that apply)
Do you have a known allergy to latex?
Do you have any physical limitations to be considered for volunteer placement?
Do you require any special accommodations?
Background

Please answer accurately.  We conduct full background checks on all candidates.

Have you ever been convicted of a felony or misdemeanor?
Whether or not formally charged or convicted, have you ever been arrested for a drug or sex related offense?
Volunteer's Certification, agreement, and notice. (Please read carefully)

I certify that all information in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for volunteer service and may result in my dismissal, if discovered at a later date. I understand that Pomona Valley Hospital Medical Center requires certain information both personal and professional from me to evaluate my qualifications for volunteer service. I understand that in review of my application, a background investigation may be conducted. I authorize and realease all past and present emplyers personal references,and any other organization to answer all questions asked concerning my previous employment and/or volunteer record, ability, character, emotional background, military services, criminal, and if applicable, driving history.

In consideration of my application for volunteer service, I authoriz Pomona Valley Hospital Medical Center and all associated entities, to conduct an investigation which may include, but is not limited to, the performance of medical examinations, drug screening, reference verification, driving history, military service, and criminal background check which may be in the files of any federal, state, or local criminal justice agency. I understand that any information requested is for the sole purpose of gathering information accurately for use in the above-mentioned volunteer and background investigation.