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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:
Street address:
City/State/Zip:
E-mail address:
Phone number(s):
Gender:
Occupation/former occupation:
Skills/Special Training:  
Volunteer Experience:  
From the list of Volunteer Opportunities, please choose three areas where you would like to volunteer:
In the event of a disaster, would you be willing to volunteer extra time in the event of a disaster?
Have you ever been convicted (including convictions now on appeal) by any law enforcement authorities for any violation of any law?
Is there anything else you would like us to know about you?  
Personal reference:
Name:
Phone number:
How does this person know you?
Emergency contact info:
Name:
Relationship:
Home phone:
Cell/Work phone:

It is a Mid Coast Hospital policy that all volunteers born after December 31, 1956, are required to show proof of their MMR immunization. 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.
        

 

 
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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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