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Online Adult Application (18 or over NOT in High School)
Personal
Education
Work Experience
Emergency Contact
References
Please provide two academic, professional or volunteer references who are not related to you
If yes, how many hours do you need to complete?
Volunteer Agreement
I authorize the Volunteer Office to contact the references provided by me to obtain the information pertinent to my responsibilities as a volunteer at The Hospital of Central Connecticut.

I agree to abide by the policies and regulations of The Hospital of Central Connecticut and the Volunteer Services Department and to participate in orientation and training required by the hospital.

I will hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients or personnel and not seek to obtain confidential information from a patient.

I understand that I may be dismissed from my duties if I fail to comply with hospital policies and procedures, willful wrongdoing or negligence and/or performing duties outside of my service guidelines, inappropriate behavior, or any other circumstances deemed contrary by the Manager of Volunteer Services to the best interests of the hospital.

I certify that the facts set forth in this application are true and complete to the best of my knowledge.

I understand that if I am accepted into the Volunteer Services program, false statements may result in my dismissal.

I understand that I am expected to inform the Department of Volunteer Services of any significant change in my health status that would negatively impact on my ability to perform the tasks to which I am assigned.
* If you are a high school student completing the adult application, it will be rejected . Please see our website for teen application information.