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Emergency Department Research Assistant Application

* Required fields

Personal Information



Emergency Contact

Employment Information


Education/Training Information

Previous Health-Related Experience



Recent Volunteer Experience

Please provide the contact information for two non-family members who can discuss your suitability to volunteer in a hospital setting. We will send them a letter of recommendation form via email attachment to complete.

Criminal Background Information

Have you ever been convicted of a misdemeanor or felony that was not dismissed, expunged, or sealed? If yes, please provide date, charge, court, and disposition.

Please be advised that Upstate Medical University & Upstate University Hospital conducts background checks on all new hires and volunteers. Prior criminal conviction(s) may not prevent you from getting the volunteer position. However, falsifying your volunteer application is grounds for withdrawal of a position offer or termination.


Required Attachments

I submit my name for consideration to volunteer at University Hospital. I understand that, ideally my association as a volunteer will extend far into the future, but a commitment of at least 100 hours is expected during the first 6 months of service. In addition, the college volunteer program is based on a per semester basis and requires a 50 hour commitment per semester.

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