The Research Corporation of the University Of Hawaii

VOLUNTEER APPLICATION FORM

Policy: 3.220 RCUH Volunteers
Applicant Information
1. Legal name:
Last First MI
/ 2. Date of Birth:
MM/DD/YYYY
// / 3. Telephone #:
() - / 4. Email Address:
5. Street Address, Apt. #
/ 6. City, State, and Zip Code / 7. Sex Male Female
8. Highest Level of Education: High School Associate’s Degree Bachelor’s Degree Master’s Degree Other:
9. Indicate position applying for: OANRP volunteer / 10. Explain your Interest in this position:
11. Indicate any Certifications, Licenses or Work Experience that you believe would qualify you for this position.
Backpacking/Camping
Clerical/Office work
/ CPR/First Aid/AED Cert.
Landscaping/Reforestation
/ Driver License
Other (Specify):
None
12. Have you volunteered with RCUH before? Yes No
13. Have you volunteered with any other organization(s) doing similar volunteer work? Yes No
If yes, please list your most relevant experience. Include the name of the organization and briefly describe what you did.
14. How often do you go hiking?
I have never hiked before / I go hiking on a regular basis (at least once every month)
I go hiking on occasion (a few times per year) / Other (Please specify)
Volunteer Duties
Volunteers must be prepared to hike two or more hours (round-trip) to and from the various work sites in the field. Some of these hikes include significant elevation gains along steep, uneven terrain and possibly under inclement weather conditions. The hiking terrain and level of difficulty will be described to volunteers before each trip and major hazards will be identified. The hike and project details will be described again in the safety briefing on the day of the hike.
a. Are you able to fulfill the hiking duties required for a volunteer position?* Yes No
b. Please list any physical limitations that may impact your ability to fulfill volunteer duties. If none, please write “none”
*If you are unable to fulfill the hiking requirements for the volunteer position, we will work with you to determine an alternative project that suits you.
Reference
Please list a reference who can attest to your ability to qualify for a volunteer duties.
Reference Name: Phone Number: Email: Relationship to applicant:
Current Employment (If this does not apply, please write N/A)
Name of Company: Job Title: Supervisor’s Name: Supervisor’s Phone #: Work Schedule:
Emergency Contact
In case of emergency, who should we notify?
On Island (REQUIRED)
Please list someone who would be able to meet you at the hospital in the event of an emergency.
Name Relationship
Phone Number(s)
Primary () - Secondary () - / Other Emergency Contact
Please list any additional person you would like us to contact in the event of an emergency.
Name Relationship
Phone Number(s)
Primary () - Secondary () -
NOTICE TO APPLICANT
(PLEASE READ CAREFULLY)
I certify that the information provided on this Volunteer Application Form is true and accurate. I am authorizing the Project to contact my references and/or current employer provided. I have read the Project’s Volunteer Program Outline and the Volunteer Position Description. If selected, I will comply with all requirements specified by my supervisor and acknowledge that the job offer for this volunteer position is conditional upon successful passing of a criminal background check of which I authorize RCUH to access this information.
I fully understand what is expected of me and the physical demands for the position if I am selected.
At no time do I (as a Volunteer) have any expectation of paid compensation for the services rendered as a Volunteer. Any misrepresentations provided on this form may result in my immediate dismissal from the program.
Signature of Applicant ______Date
Signature of Parent/Guardian______Date
(if Applicant is under 18 years)
For Principal Investigator/Project Use Only:
Date Interviewed:______Date of Reference Check:______Reference Name:______
Status: □Selected □Not Selected
Name of Project Volunteer Coordinator:______Phone#:______
Email Address:______
Period of Performance: ______to ______
Principal Investigator Signature:______Date:______
RCUH Human Resources Use Only:
Criminal Background Check Completed By: ______Date: ______
□No Criminal History □No Criminal History w/in last 10 yrs. □Conviction bears no rational relationship to job.
RCUH Human Resources: Approved OR Disapproved
Authorized by:______
RCUH Human Resources Department Date

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RCUH Form E-3

Created 09/2009 (Revised 01/2011, 03/2011, 03/2014, 04/2015)