• 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.

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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:
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