CHI St. Alexius Health Bismarck Volunteer Form

Thank you for your interest in volunteering with CHI St. Alexius Health Bismarck. Please complete the following application which will be used to match your interests and skills with the current needs of the agency. Please complete the application and submit to Volunteer Services.

If you have any questions contact Volunteer Services at 701.530.7159 or email volunteer services.

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Personal Information

When are you available to volunteer?

Volunteers typically serve two to four-hour shifts, scheduled according to the department’s need and the volunteer’s availability. You are asked to commit at least 50 hours of service in a six-month period.

Emergency Contact
References

Please list two people, not related to you, who can serve as references. 

Reference 1
Reference 2
Conviction Record

A criminal conviction record does not by itself constitute an absolute bar to volunteering. The nature of the conviction will be examined on a case-by-case basis, including subsequent rehabilitation, and will be considered in relation to the responsibilities of the position sought in making each employment decision.

As a condition of volunteering, I give permission for CHI St. Alexius Health to conduct a background check on me, which may include a review of the sex offenders’ registries, references, and criminal history records. I understand that my appointment is conditional upon the information provided. I hereby release and hold harmless from liability CHI St. Alexius Health, its officers, employees, and volunteers, as well as any person or organization that may provide information to CHI St. Alexius Health.

I also understand that this is an application for a volunteer position only. CHI St. Alexius Health is not obligated to provide placement, nor is the applicant obligated to accept the position offered.

The information that I have provided may be verified by contacting persons or organizations named in this application, or by contacting any person or organization that may have information concerning me, or by conducting the background checks described above. By signing this application, I verify I have read the information disclosed and certify that it is true and correct.