Thank you for your interest in volunteering at MetroHealth.

Please fill out the application below to begin the process. If you are 18 or over, we will be conducting a criminal background check and fingerprinting as part of our onboarding process, and you must pass drug and nicotine screening. Please note that use of e-cigarettes (vaping) and nicotine replacement therapy products (gum, patches, etc.) are not permitted and will result in a positive screening.

Summer Student Volunteer Program Application

*Please note that all summer volunteers must be at least 15 years old by June 1, 2020.
Personal Information
Title
First name
Middle name
Last name
Street address
City
State
Zip/postal
Home phone
Mobile phone
Month of Birth
E-mail
Volunteer Assignments
Ambassadors
Physical and Occupational Therapy-Inpatient
Cancer Care Center
Physical and Occupational Therapy- Outpatient
Child Life
Reach Out and Read
Emergency Department
Resident Enrichment Activities
Patient Relations Rounds
Arts in Health
Patient Safety Rounding
Volunteer Interest
Please check the location(s) where you would like to volunteer
Why are you interested in volunteering with The MetroHealth System?
Days of the week available to volunteer
Time of day available to volunteer
Have you ever worked or volunteered for The MetroHealth System?
If yes, indicate the facility, your position, and dates of service:
References
Please list two persons we may contact for a personal reference. Do not list relatives.
Name
Phone
Street address
City
State
Zip/postal
Name
Phone
Street address
City
State
Zip/postal
Employment/Education/Volunteer Experience
Employment Status
Employer
Position
Start Date
I am a student.
School
Volunteer Experience
Describe your present/past volunteer experience, including name of organization, type of assignment, and dates:
Miscellaneous
1) Are you receiving an Ohio Public Employees Retirement System (OPERS) disability benefit?
Person to be contacted in case of emergency
Contact name
Relationship
Phone
Volunteers under the age of 18
Are you under18?
If you are under 18 your parent or guardian must read and sign this statement.

I give my permission for my son/daughter to volunteer for The MetroHealth System. I verify that my son/daughter has not been convicted of any felonies or misdemeanors. I also verify that my son/daughter will be at least 15 years old by June 1, 2020.

Minor date of birth
Parent or Guardian Name
Parent/Guardian E-mail
Date
Acknowledgement and Signature

I certify that all the information on this form is true and accurate, I understand that all application information will be verified and that false statements or omissions will be considered grounds for immediate dismissal, no matter when such information is discovered or reported to The MetroHealth System. I understand that if I volunteer, I must become familiar with and abide by all the policies of The MetroHealth System. I further understand that my volunteering is conditional upon satisfactory completions of reference and background checks, as well as drug and nicotine screening. Certain conditions would not apply if the volunteer is a minor.

Applicant Name
Application date
By submitting this form, I attest that the information I have provided is true and accurate.
I Agree