Application for the Department of Research and Discovery’s Volunteer Internship Opportunities





Emergency Contact


Nothing contained in this volunteer application shall be deemed to create an employment contract between Stamford Hospital and myself for either employment or for the providing of any benefit. The granting of an interview shall likewise not create such a contract. No promises regarding my volunteering or inducements to volunteer have been made or offered to me and I understand and agree that no such promises are binding upon Stamford Hospital unless made in writing and signed by the chief executive officer of Stamford Hospital. If I am selected as a volunteer, I understand and agree that I have the right to terminate the volunteer relationship at any time and for any reason and the Stamford Hospital have a similar right. After receiving a conditional offer to participate in a volunteer program, I may be asked to submit to a physical examination that includes a drug test. Any offer to participate in a volunteer program is contingent upon my satisfactory completion of the physical examination, satisfactory references verification, and receipt of a negative drug test result. Such drug test shall be conducted in conformity with the Connecticut drug testing statute (Conn. Gen. Stat. 31-51t to 51aa).I hereby give Stamford Hospital to which I am applying for a volunteer position, and their agents, permission to undertake verification of the information I have provided, to investigate me regarding any criminal records and to investigate my previous employment, educational background and references, and I release them from any liability and responsibility from doing so. Pursuant to section 31-128f of the Connecticut General Statutes, I also hereby release all parties supplying references and other personally identifiable information from any liability or damage whatsoever arising there from. My volunteer application is not complete until I have read and signed the Background Verification Disclosure sheet that will be provided to me in a follow-up once this application is submitted. The information supplied by me on this volunteer application is true and complete to the best of my knowledge. I understand that the discovery of any misrepresentation or omission of facts in the volunteer application may result in revoking my volunteer status.

*My signature below indicates that I understand and agree with all of the above statements

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