The Research Corporation of the University Of Hawaii
VOLUNTEER APPLICATION FORM
Policy: 3.220 RCUH Volunteers
Applicant Information
1. Legal name:
Last
First
2. Date of Birth:
MM/DD/YYYY
MI
/
5. Street Address, Apt. #
6.
8. Highest Level of Education:
3. Telephone #:
( )
-
/
City, State, and Zip Code
High School
7. Sex
Associate’s Degree
9. Indicate position applying for: OANRP volunteer
Bachelor’s Degree
4. Email Address:
Male
Female
Master’s Degree
Other:
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
CPR/First Aid/AED Cert.
Clerical/Office work
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 occasion (a few times per year)
I go hiking on a regular basis (at least once every month)
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:
Page 1 of 2
RCUH Form E-3
Created 09/2009 (Revised 01/2011, 03/2011, 03/2014, 04/2015)
Supervisor’s Phone #:
Work Schedule:
Emergency Contact
In case of emergency, who should we notify?
On Island (REQUIRED)
Other Emergency Contact
Please list someone who would be able to meet you at the hospital in the
event of an emergency.
Please list any additional person you would like us to contact in the event of an
emergency.
Name
Name
Relationship
Phone Number(s)
Primary (
)
Relationship
Phone Number(s)
-
Secondary (
)
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
Page 2 of 2
RCUH Form E-3
Created 09/2009 (Revised 01/2011, 03/2011, 03/2014, 04/2015)
Date