• 1700 SW 7th Street, Topeka, Kansas 66606-1690
  • 785-295-8000

Adult Volunteer Application

To apply for a volunteer position, please fill in the form below and click Submit. Once you have submitted your request, you will be able to print a copy to keep for your records.

If you listed your spouse as an emergency contact, please also list below an emergency contact other than your spouse.
May we contact the above employer for a reference?

May we contact the above employer for a reference?

May we contact the above employer for a reference?

Reference #1:
Reference #2:
Have you ever been convicted or received a deferment for a crime? (Note: You do not need to disclose minor traffic violations such as speeding or parking tickets. Reckless and/or drunk driving is not a minor offense and should be disclosed.

Is your name or a name you know to be referring to you on any local, state or national registry, including but not limited to registries for sexual offenders?

Have you been ordered by a judge to do community service as an alternative to a fine or jail sentence?

If placed as a St. Francis Health volunteer, will your volunteer hours be used for court-required community-service hours?

Do you have a parole officer?

Are you a citizen of the United States?

If not, do you have a green card or other valid authorization to reside in the United States (visa, permanent resident card, etc.)? A copy will need to be provided if you are placed as a volunteer.

Do you know anyone at St. Francis Health?

Are you related to anyone working at St. Francis Health?

Has St. Francis Health ever employed you?

I understand that: