Volunteer Application | Volunteer Opportunities at ACH

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How You Can Help • Events & Classes • Conferences/Courses • Home

Personal Information
	Mr.- Mrs.- Ms.-
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Message Phone:
E-mail Address:
Re-enter E-mail Address:
Social Security Number:
Emergency Contact Name:
Relationship to Applicant:
Emergency Contact Phone:

Employer Information
Employer Name:
City:
State:
Your Job Title:

Past Volunteer Experience
Organization:
Phone Number:
City:
State:
Supervisor:
Dates Volunteered:
Describe your work:

Areas of Interest (check all that apply)
	Hospital, patient contact
	Hospital, non-patient contact
	Foundation
	Gift Shop
	Clerical
	Clinic Work
	Waiting Rooms

ACH References
List any friends or relatives working for Arkansas Children's Hospital:
Name:
Relationship:

Name:
Relationship:

Name:
Relationship:

Skills
Which of the following skills do you have?
	Typing
	Computer
	Bilingual
What Language?
	Arts and crafts
	Storytelling
Other

Time Available to Volunteer
Check all that apply	Morning- Afternoon- Evening- Weekend- Monday Tuesday Wednesday Thursday Friday Saturday Sunday
How Did You Hear About Us?

Education/Background
Have you ever been convicted of a felony, i.e., a serious crime?	Yes No
If yes, please describe the nature of the offense and the punishment you received

If you are over 18 years of age:
Last grade completed
List high school, college, vocational, business or other schools attended:
School Name:
City:
State:
Degree:
Date Graduated:
Personal References, please list three (do not list relatives):
Name:
Daytime Phone:

Name:
Daytime Phone

Name:
Daytime Phone:


If under 18 years of age (ages 14-17) Please note: We are unable to accept volunteers under the age of 14
What school do you attend?
What grade are you in?

In order for your application to be considered, we must have, on school letterhead, two letters of reference from a teacher, club sponsor, principal or counselor. If this is for a service learning credit, we will need a letter stating your acceptance in your school’s service learning program. Please send all letters to Arkansas Children's Hospital, Volunteer Services Program, 800 Marshall Street, Slot108, Little Rock, Arkansas 72202.

Please read the following carefully:
I hereby apply to the Arkansas Children’s Hospital for volunteer assignments, and, if accepted, I agree to abide by all rules and regulations and perform all duties assigned to me to the best of my ability according to the prescribed philosophy of the hospital.

I understand and agree that if I become a volunteer, I will be a volunteer "at will." In volunteering, either the hospital or I may end the relationship at any time for any reason. No representative of the hospital has the authority to vary this arrangement. I also agree that nothing in the hospital’s policies, rules, regulations or handbook changes this relationship, or may be considered as a contract of employment.

Arkansas Children's Hospital is an Equal Opportunity/Affirmative Action Employer. Opportunity for Volunteer Service is provided without regard to race, color, religion, sex, origin, age, disability or veteran’s status.

For your application to be considered, you must click below signifying that you have read the information above

Yes No

Arkansas Children's Hospital, 800 Marshall St., Little Rock, AR 72202-3591, (501) 364-1100 or TDD (501) 364-1184

ACH is a tobacco free campus.