Ascension St. Vincent's Riverside Hospital

  • Hospital/Medical Center
  • Emergency Care
  • Imaging
Call us for daily hours
Contact Information
Employment Information
Experience Information
Availability Information
Reference 1 - Must not be related to you
Reference 2 - Must not be related to you
Reference 3 - Must not be related to you
Emergency Information
Emergency Contact 1
Emergency Contact 2
Emergency Contact 3
Additional Information
Terms and Conditions

Please Read Carefully

I hereby certify that all the facts and information listed on this application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application after I am accepted as a volunteer may result in my dismissal.I hereby authorize the Medical Center to investigate all statements contained in this application, to interview the references listed on this application. I authorize the references listed to give the Medical Center all facts, opinions and any other information they may have, personal or otherwise, and release all such parties om any liability which may allegedly arise from furnishing such information to the Medical Center, included but not limited to, any liability for defamation or invasion of privacy. I hereby authorize the Medical Center to perform a background check as necessary. I certify that I have read, understand and agree with the above.

I understand that my submission of this application does not guarantee my placement as a St. Vincent's volunteer. All volunteer applicants are subject to screening which includes application verification, personal interview, criminal background and reference checks.