<p>Volunteer Application – San Francisco 4131 Geary Blvd. #305 San Francisco, CA 94118 Phone: 415-833-2788 Email: [email protected] Personal Data</p><p>Name:</p><p>Address: City/Zip:</p><p>E-mail Address: Phone:</p><p>Presently Employed? No  Yes  If yes, where? Have you ever been employed by Kaiser  Yes If yes, name of facility When: Permanente or any other Kaiser Organization?  No or organization: Where: Position Held: Name Used:</p><p>Volunteer Type:  High School Student (age 16 & 17)  Adult (age 18 and over) </p><p>Volunteer / Work / Educational Experience</p><p>Volunteer Experience:</p><p>Work Experience:</p><p>Why are you seeking to volunteer?  Personal commitment  School Program  Other: ______</p><p>Please explain:</p><p>Are you currently attending school? No Yes If so, where?</p><p>Level of Education Completed: Field of Study:</p><p>Skills & Attributes</p><p>Please indicate below the attributes and skills that you possess: </p><p>Customer Service Creative Technical Positive Attitude Musical Instrument Computer Skills Initiative/Proactive Drawing/Painting Telephone Listening Skills Humor/Storytelling Office Machines Patience Singing Reception Desk Skills Understanding/Empathy Sewing/Needlework/Crafts Typing Please describe any other attributes/skills/special trainings:</p><p>Please share your hobbies/ special interest/ extracurricular activities:</p><p>Language Proficiency (other than English):</p><p>Service & Availability</p><p>How did you learn about the Volunteer Program?</p><p>Do you have a preference for service area?  No  Yes </p><p>If yes, please list your top three choices: 1) 2) 3)</p><p>Can you commit to volunteering for a minimum of one year? No  Yes </p><p>Do you have any limitations you would like us to know about?</p><p>Please indicate the time of day and days of the week you are available to volunteer. Shifts may include: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Mornings</p><p>Afternoons</p><p>Evenings </p><p> Applicant Statement</p><p> I certify that all answers in this volunteer application are true and correct and have been given voluntarily  I understand that completing an application does not guarantee acceptance into the Volunteer Program  I understand that the position of Volunteer requires that I be available to volunteer for a minimum of 1 year  I understand that incomplete applications will not be considered  I understand that volunteering may not lead to employment</p><p>Signature ______Today’s date ______</p><p>Parental/Guardian Signature: (under the age of 18 years old)</p><p>My child, (insert name) ______has my consent to participate in the Kaiser Permanente San Francisco Volunteer Services Program should he/she be selected as a Volunteer. I assume all responsibility for his/her service in this program to be in accordance with the policies, procedures, and expectations of Kaiser Permanente volunteers. I have reviewed the description of the program. My child may participate in all activities in connection with his/her assigned duties, with or without accommodation. In the event I cannot be contacted, I hereby give permission for Kaiser Permanente to administer emergency health care to my child.</p><p>Parent/Guardian Signature ______Today’s date ______</p>