MetroHealth Loving Paws Application

Next Steps: sign up for the volunteer interview, and Healthscreening including the criminal background check, fingerprinting, TB screening and drug screening. Please note that all volunteers must be vaccinated for COVID-19 and must receive the flu vaccine yearly.

Yellow fields are required to be filled in.

New User Details

User ID

User ID (verify)

Password

Password (verify)

You must be 16 years of age or older to volunteer. Please fill out the application below.

Personal Information

Title

* First name *

Middle name

* Last name *

* Street Address Line 1

Line 2

* City *

State *

* Zip/postal *

* Phone *

* E-mail *

* Dog Name

Breed, Age.

* Certifying Therapy School of the dog(s).

Are you a current MetroHealth Employee? *

Days of the week available to volunteer *

Time of day available to volunteer

Have you ever worked or volunteered for The MetroHealth System? *

If yes, indicate former employee or former volunteer, the facility, your position, and dates of service:

References

Please list two persons we may contact for a personal reference. Do not list relatives.

Name

Phone

Name

Phone

Employment/Education/Volunteer Experience

Employment Status & School Info

Employment Status

Employer

Position

I am a student.

School -

Volunteer Experience

Describe your present/past volunteer experience, including name of organization, type of assignment, and dates:

Miscellaneous

1) Are you receiving an Ohio Public Employees Retirement System (OPERS) disability benefit? *

2) Are you applying to fulfill a school, graduation or government program requirement for service? Please specify how many hours you need and any other special requirements. *

Please Explain if you selected YES:

Person to be contacted in case of emergency

Contact name

Relationship

Phone

Volunteers under the age of 18. If under 18 please provide a date of birth.

Under age 18

Date of Birth

If you are under 18 your parent or guardian must read and sign this statement. Please put n/a if you are not under 18.

I give my permission for my son/daughter to volunteer for The MetroHealth System. I verify that my son/daughter has not been convicted of any felonies or misdemeanors.

Parent or Guardian Name *

Today's Date

Acknowledgement and Signature

I certify that all the information on this form is true and accurate, I understand that all application information will be verified and that false statements or omissions will be considered grounds for immediate dismissal, no matter when such information is discovered or reported to The MetroHealth System. I understand that if I volunteer, I must become familiar with and abide by all the policies of The MetroHealth System. I further understand that my volunteering is conditional upon satisfactory completions of reference and background checks, as well as a drug screening. Certain conditions would not apply if the volunteer is a minor or employee.

By submitting this form, I attest that the information I have provided is true and accurate.

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Signature of Applicant. Please use your mouse or finger to sign.