Niles Volunteer Opportunity

Thank you for your interest in volunteering at Lakeland Hospital, Niles.

Please complete the application form below.

Personal Information

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Have you ever served as a volunteer with Lakeland?

Home Address

Current Status

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Education (check all that apply)

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Work Experience (Paid employment - most recent job first)

Length of Service

Length of Service

Volunteer Experience

Length of Service

Length of Service


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Availability (We require a 75 hour commitment annually)




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Placement Preferences

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Referral Source (How were you referred to the Volunteer Program?)

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Emergency Contact

Do you have any medical conditions that would affect your ability to perform your volunteer duties, or that the volunteer office should know about?

References - Please provide us with the names and phone numbers of two persons outside your family who know you and would be willing to respond to a reference request (i.e. neighbor, minister, employer, teacher):


Have you ever been convicted of a crime?

Are there any felony charges outstanding?

Are you volunteering to satisfy a court required community service?

If yes, please list your probation officer’s name and phone number and the number of hours required. 
We will ask for your SS# on or before your interview to conduct a background check. By checking the box you give Lakeland Health the authorization to conduct a criminal background check on me.
Uniform/Badge Agreement
Information Agreement

Volunteer Requirements

As a volunteer for Lakeland HealthCare, I agree to the following:

  1. I shall hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, physicians or hospital personnel.
  2. My services are voluntarily donated to the hospital without expectation of compensation or future employment.
  3. I understand that it is a violation of hospital policy to solicit business or act as an agent for any outside business or to solicit business from patients and/or staff. I understand that violation of this policy may result in my termination as a volunteer
  4. I shall not sell or attempt to sell goods or services, request contributions or solicit persons to sign or distribute political materials on hospital premises, unless I receive prior authorization from the Manager of Volunteer Services to engage in these activities.
  5. I shall submit to health requirements, which include TB skin tests, a seasonal flu shot and any other immunization that may be necessary as a part of my volunteer service.
  6. I authorize Lakeland HealthCare to photograph me and to use such photographs for educational, public relations, charitable and other such purposes it may deem appropriate.
  7. I shall make my best effort to fulfill my commitment to Lakeland HealthCare by completing all assignments that I accept. I recognize that volunteering will impact my life and have made appropriate schedule and/or lifestyle adjustments to support my commitment to Lakeland.
  8. I shall be punctual and conscientious, conduct myself with dignity and courtesy and endeavor to make my work professional in quality. I will be friendly, caring, compassionate, helpful and efficient. I will perform my volunteer service to the best of my ability. What I do matters, I am valued and I make a difference.
  9. As a Lakeland volunteer, I agree to commit to at least one year of service and work a minimum of 75 hours per year as an active volunteer. As a junior/student volunteer, I agree to commit to at least six months of service and work a minimum of 75 hours within those six months. I understand that my commitment is automatically extended beyond the stated minimum requirement, unless termination is requested.
  10. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status as a result of: a. Failure to comply with hospital policy, rules and regulations; b. Four (4) consecutive absences without prior notification; c. Unsatisfactory attitude, work or appearance; d. Any other circumstances that, in the opinion of the Manager of Volunteer Services, would make my continued service as a volunteer contrary to the best interests of the hospital.
  11. I agree to inform the Supervisor of Volunteers when I decide to resign my volunteer position and agree to an exit survey. I also agree to hand in my ID badge and uniform upon resignation.
Volunteer Requirements
Acknowledgement of Requirements
Your generosity can make a difference.