Preplaced Volunteer Application

Please complete this application if you are a preplaced volunteer at Johns Hopkins Medicine. Thank you!

New User Details

User ID

User ID (verify)

Password

Password (verify)

Johns Hopkins Volunteer Services - Preplaced Volunteer Application

Please select the hospital where you have arranged to volunteer:

Are you at least 18 years of age?

Personal Information

* First Name

MI

* Last Name

Chosen First Name

Preferred Pronouns

Other Pronouns

* Date of Birth

* Home Address

* City

State

* Zip Code

* Primary Phone (Mobile, if available)

Primary Language

Additional language(s): select all that apply

Emergency Contact

Parent/Guardian

* Contact name

* Relationship

* Parent/Guardian Name

* Primary Phone

Other Phone

* Parent/Guardian Primary Phone

* Emergency Contact E-mail

* Parent/Guardian E-mail

Education/Employment

Highest Grade Level Completed

What is your current Employment/Education status?

Describe Current Status

Former Occupation

School Name

Academic Major/Career Goal

Are you a current Johns Hopkins Medicine Employee?

Current Employer

Which JHM Entity do you work for?

JHED ID

Employee Department/ Unit

Employment Position/Title

Employee Supervisor Name

Employee Supervisor Email

Preplaced Department Information

Please select the Department where you will be volunteering

Peer Support - Radiation Oncology

Please select the Volunteer Program you are approved for:

Emergency Department

Human Resources

Occupational Health

Main Lobby (Patient Escort)

Office

Spiritual Care

Surgical Waiting Room

Clinical Support Services/Patient Transport

Junior Volunteer Team

Patient Care Units

Oasis

Pet Therapy Facilitator

Pathology

Other

Preplaced Department Name (Please select from the list. If you do not see your department, please select 'Other')

Other Department:

* Volunteer Supervisor Name

* Volunteer Supervisor's Email Address

Final Steps

Volunteers are an essential part of Johns Hopkins Medicine. Assignments will be made in accordance with your interests, abilities and goals and in consideration of the needs of the Hospital, which will be the ultimate determining factor. Volunteer assignments will be made only upon the request and agreement of the department to which the volunteer is assigned.

* I certify all information is true and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest. I release the agency from any liability whatsoever for supplying such information.

* As the Parent/Guardian of the applicant, I certify that all information is true and applicable to the minor who is applying to volunteer.