Volunteer Application Form

Thank you for your interest in becoming a Versiti volunteer. Because of the dedication and generosity of volunteers like you, we are able to provide life-saving products to patients in the communities we serve.

If you enjoy being with people, have great customer service skills, and are willing to share your time and talents with our donors and patient families, we invite you to begin the application process.

In order to become an Versiti volunteer, you must:

Be at least 17 years old to become a volunteer
Be at least 21 years old to become a blood products delivery driver
Understand that a criminal background check will be performed
Attend a volunteer placement interview

Please note that all information submitted on this Volunteer Application Form will be kept confidential and will only be used by Versiti Volunteer Services.

Title:

First Name*:

Last Name*:

Street 1*:

Street 2:

City*:

State*:

ZIP*:

Primary phone:

( ) -

Email*:

Date of Birth*:

References

List two people not related to you who can attest to your character. A personal reference cannot be one from a family member.

Relation status:

First Name*:

Last Name*:

Phone*:

( ) -

Relation status:

First Name*:

Last Name*:

Phone*:

( ) -

Commitment & Obligation

What length of commitment are you willing to make? (Note: We ask that you be willing to volunteer at least 4 hours per month and at least a 6 month commitment.)

Will this volunteer position fulfill an obligation for community service or a school/church assignment? If so, How many hours are required for this assignment? (Note: We do not accept volunteers with court ordered community service.)

Choose Your State*:

Please select the Versiti blood center you would like to volunteer at:

Illinois

Illinois Locations:

Illinois Interests:

Donor Center Greeter/Café
Blood Product Delivery Driver
Café
Project Support

Once you’ve applied someone from Versiti will contact you with more information.

Background Check – Authorization Waiver and Release Statement

We are grateful for your application to become a volunteer. Please note the background checks are performed on all potential volunteers. If you are volunteering for a delivery driver position, we will also request your driver history records from the Department of Motor Vehicles.

I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company and its consumer reporting agency Employment Background Investigations (“EBI”) to obtain information on me from any law enforcement agency, administrator, local, state or federal agency, institution, school or university (public or private), information service bureau, employer, insurance company or the National Records Center to furnish any and all background information including, but not limited to; criminal and public record history, driving and/or motor vehicle records, transcripts, grades and attendance records, employment history, references and workers’ compensation documents (including from the State of Pennsylvania, the Industrial Commission of Arizona and all other states where permissible).

If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during, as permitted by law, my employment, contract, or volunteer period. I authorize without reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above-mentioned information.

I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights.

If you have any questions concerning this background screening content, please contact Employment Background Investigations at 800-324-7700.

When you check the “I AGREE” box below you are indicating that you understand that a criminal background check will be done with the Department of Justice, without liability to Versiti.

All of the information above is, to the best of my knowledge and belief, true, correct and complete. I understand a false answer to any question on this application is grounds for termination of the application process, or dismissal from Versiti’s Volunteer Program.

* Required field.