Volunteer Application Online

Note: Fields marked with an * indicates required field

McLaren Lapeer Region
Volunteer Application Form

 


 
    
 
   

 

 
    
   
   


 
 
 
 
Employment
 

    
    
   
      
     
 
   
References (Other than relatives)
   
   
 
 
    
  
   
Emergency Contact:




 
Preferred Service and Time



 
 



 
 



 
 
BACKGROUND CHECK (To protect your privacy, this form will only be seen by MLR Volunteer Services staff)
 
 
    
     
I GIVE MCLAREN LAPEER REGION PERMISSION TO CHECK MY CRIMINAL HISTORY WITH MICHIGAN LAW ENFORCEMENT AGENCIES, AND TO SEARCH MY HISTORY FOR INCIDENTS OF FRAUD WITH THE FRAUD AND ABUSE CONTROL INFORMATION DATABASE. I AUTHORIZE MCLAREN LAPEER REGION AND ITS AFFILIATES OR IT’S DESIGNATED AGENTS TO MAKE WHATEVER INQUIRES IT MAY DEEM NECESSARY IN CONNECTION WITH MY VOLUNTEER APPLICATIONS. AS PART OF SUCH INQUIRES, MCLAREN LAPEER REGION HAS MY PERMISSION TO CONTACT PERSONS WHO MAY HAVE INFORMATION RELATING TO MY SUITABILITY FOR VOLUNTEER WORK. I FURTHER AUTHORIZE MCLAREN LAPEER REGION, IN ITS SOLE DISCRETION TO FURNISH COPIES OF THIS AUTHORIZATION AND MY VOLUNTEER APPLICATION TO ANY PERSONS IN CONNECTION WITH THE ABOVE PROCESS.

I UNDERSTAND THAT MY ENROLLMENT AS A VOLUNTEER IS CONTINGENT UPON SUCCESSFUL COMPLETION OF THE APPLICATION PROCESS. FOR MY CRIMINAL HISTORY TO BE VERIFIED AND TO HAVE MY HISTORY SEARCHED FOR FRAUD AND ABUSE. I AGREE TO RELEASE MCLAREN LAPEER REGION, IT’S AFFILIATES, AND ALL PARTIES FROM ANY LIABILITY FOR ANY DAMAGES THAT MAY RESULT FROM FURNISHING SUCH INFORMATION.

IF I AM SELECTED AS A MCLAREN LAPEER REGION CENTER VOLUNTEER I AGREE TO ABIDE BY ALL HOSPITAL RULES, REGULATIONS AND EXPECTATIONS. I UNDERSTAND THAT EITHER PARTY MAY CANCEL THIS RELATIONSHIP AT ANY TIME.

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO INFORM MCLAREN LAPEER REGION OF ANY CHARGES.

   
Note: A criminal history will not necessarily disqualify an applicant. A criminal record is one piece of information that will be considered in determining the appropriates of an individual to be a McLaren Lapeer Region Volunteer

AS A VOLUNTEER, YOU WILL HAVE THE OPPORTUNITY TO LEARN A GREAT DEAL ABOUT THE HEALTH CARE INDUSTRY. THE EXPERIENCE THAT YOU ACQUIRE MAY BE OF VALUE IN THE FUTURE. HOWEVER, THAT FACT THAT YOU HAVE BEEN ACCEPTED AS A VOLUNTEER BY MCLAREN LAPEER REGION IS NOT TO BE CONSTRUED IN ANY MANNER AS A GUARANTEE OF FUTURE EMPLOYMENT OR A COMMITMENT THAT YOU MAY BE CONSIDERED FOR OR OFFERED EMPLOYMENT BY THE MEDICAL CENTER AT SOME FUTURE DATE.