Certified Volunteer Chaplain

First Name

Last Name

Phone Number

Date of Birth

What Facility would you like volunteer with?

Have you had a COVID-19 vaccination? (Please choose the most accurate)

How many hours per week are you interested in volunteering?

Please list any Chaplaincy-related training, certificates or degrees you have received.

Please provide one professional (non-family member) reference (Name, phone, relationship.)

Attestations

I affirm that I am at least 18 years of age.

I understand that submitting this application does not guarantee I will be selected as a volunteer chaplain.

I agree to submit to a background check , chaplaincy training and facility training before serving as a volunteer chaplain with Signature Healthcare, LLC.

I agree to abide by the rules, regulations and expectations of Signature Healthcare, LLC.

I agree to submit to any testing required to maintain proper infection control protocols, including (but not limited to) Covid-19 testing.

Please complete the COVID Volunteer Training Agreement

Contact Information