Volunteer Application

Volunteer Application

Friends of Coffey Health System welcomes men and women (at least sixteen years of age) who are willing to give of their time and energy to support and enhance the services offered by Coffey Health System.

Volunteers may serve up to four hours per week. Prior to service, each volunteer must complete an application, two TB skin tests, and orientation. Orientation includes instruction regarding patient/resident privacy laws; strict adherence is required.

To apply online, please submit the following information.

Full Name *

Complete Mailing Address *

Telephone Number *

Email Address *

Name, Address, and Telephone of Person to Contact in Case of Emergency *

If you are employed, please state your position and employer.

Previous Work Experience

What special training or skills would you like to utilize as a CHS volunteer? *

Hobbies/Interests

Previous Volunteer Experience

List professional, trade, business, or civic activitities and offices held. (You may exclude those which indicate race, religion, color, sex, national origin, or ancestry.)

Reason for Volunteering *

Areas/departments you would like to help

Shifts you are available to volunteer
Weekday 8 a.m. - 12:30 p.m.Weekday 12:30 p.m. - 5 p.m.Weekend 8 a.m. - 12:30 p.m. Weekend 12:30 p.m. - 5 p.m.

Reference #1 (Please include name, address, and telephone/cell phone number.) *

Reference #2 (Please include name, address, and telephone/cell phone number.) *

Acknowledgement of Application Process *
I understand that by submitting this application, I authorize FOCHS to contact my references. I also understand that orientation and a TB skin test must be completed before any volunteer service.

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