Welcome to Rochester General Hospital Volunteer Services Department

Internship (Workforce and Job Readiness Programs)

Check this box if you are in a workforce or job readiness program and hope to complete an internship.
Personal Information
Middle Initial
Name prefix
First Name
Family/Last Name
Gender
DOB
Application date
Home/Mailing Address
Street
Apt
City
State
Zip/postal
Home phone
Mobile Number
E-mail Address
Emergency Contact
Contact name
Relationship
Home phone
Work phone
High School
Other High School (not listed):
HS Anticipated Graduation Date
College/Grad School
Other College (not listed)
College Graduation (Anticipated Date)
Participation Information
How did you hear about our program?
Why do you want to volunteer at Rochester General Hospital?
Program Information
Which program/agency are you a part of?
How many hours do you need to complete?
Which of the following types of work and work place areas interest you the most?
Clerical / Office Assistance
Materials / Inventory Management
Environmental Services
Patient Care areas
Maintenance / Facilities
Food Service
Patient Transport
Other (explain):
References
1)
Name:
Street:
Phone:
Email:
City:
State:
Zip Code:
2)
Name:
Street:
Phone:
Email:
City:
State:
Zip Code:
Signature
Have you ever been known by any other name?
If yes, what name were you known by?
When were you known by that name?
Please read and sign:I understand that any falsification of information on this application may result in immediate termination of the application/on-boarding process or as a volunteer with the Rochester General Health System.I authorize the Volunteer Services Department to contact my references.I agree that my acceptance as a volunteer is contingent upon my passing a medical examination. Please state below any physical condition you have which should be considered when you are assigned a volunteer position in the hospital, or which we should know in case of emergency.I understand that a volunteer is expected to observe confidentiality with respect to all patient information at all times, and that failure to do so may result in my personal liability to the patient and/or the hospital.
I agree


For office use only:
Health Screening
Background Check
Orientation
Wheelchair Training
Canine Visitation