Volunteer/Student/Intern Application

Thank you for your interest in becoming a Bay Medical Volunteer. Please complete the information below.

Please indicate the type of volunteer position
you are applying for: *

Last Name: *
First Name: *
Middle Name:
Present Address:
Telephone No: *
Birth Date: *
In case of emergency, notify: *  Phone:*
Education/special training:
When are you available to volunteer?:

Please select the areas in which you are interested in volunteering:

Do you have any medical problems which would limit your abilities to perform your duties as a volunteer/intern? *

Background Information
Have you ever been convicted of a felony? *

  (An official background check will be conducted.)
Please list two personal references
Reference 1
Name: *
Phone: *
Reference 2
Name: *
Phone: *
How did you hear about the Volunteer Program?
* I understand that I am applying to become a volunteer/intern at Bay Medical, not an employee. By signing this application I am acknowledging that all information on this application is true and correct. I also agree to treat all patient and hospital information as confidential and will not discuss the condition of patients or any other information obtained by volunteering/interning at Bay Medical. I understand that breach of this agreement will result in permanent removal from the program.

We look forward to having you on our team!