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Volunteer Online Application

Please review the application process before filling out this form.
You may also print out the application in PDF format. (Confidentiality Agreement & Authorization to Release Information included. Mailing address is also in the pdf.)

Junior volunteers - go to this form.

Note: All fields required       
Please tell us:
Name:
Mailing address:
E-mail address:
Phone number(s):  
Please list your previous volunteer experiences, if any. No previous experience required!  
Occupation/former occupation:
Education/Special training:  
Hobbies/Skills/Special Interests:
Is there anything else you would like us to know about you?  
Please tell us:
Availability - please let us know when you may be available for volunteering, days and hours of the day:
In the event of a disaster, would you be willing to volunteer extra time at the hospital?
Who recommended you volunteer at Mid Coast and/or where did you hear about volunteering here?
Personal reference:
Name:
Address:
Phone number:
May we contact the reference?
How does this person know you?
Emergency contact info:
Name:
Address:
Relationship:
Home phone:
Work phone:
Rubella Immunization. It is Mid Coast Hospital policy that all volunteers born after Dec. 31, 1956 are required to show proof of immunity to rubella disease. All non-immune volunteers will be required to be immunized against the disease, at no charge, in the employee health department.

Immunization date: (enter 'none' if none)     

You will also need to complete Confidentiality and Authorization for Release of Information forms at the hospital before final approval of your application. You can view the forms here: Confidentiality and Authorization for Release of Information.
        

 

 
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Mid Coast Hospital - For a Lifetime of Caring

123 Medical Center Drive, Brunswick, Maine 04011
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Accredited by The Joint Commission. Recognized as
a Magnet™ Hospital for exceptional nursing and patient care by the American Nurses Credentialing Center.
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