09/25/09
Choose the facility which you would like
to volunteer at:
This information is kept confidential and is only submitted to the Minnesota Department of Human
Services. By signing the box below you are stating that all information is correct and current.
If you have any questions, please contact Mike Chies (Administrator), Jean Kittleson (ADON), Ryan Chies
(Assistant Administrator) or Clara Saprasa (Infection Control/Staff Development RN)
Phone: 651.633.7200
Flu Main > Flu Sign Up
Please fill out the form below. This information will be used for a Criminal Background Check done for all employees & Volunteers.
NOTE: Fields that have (*) are optional!