Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. As a condition of volunteering, IU Health requires all volunteers to receive various vaccinations, including the influenza and COVID-19 vaccines. Volunteers will also be provided the option to submit proof of previous vaccination.

Thank you for your interest in volunteering at IU Health!

Contact Information

First name:

Last name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Email address:

Education

Education:

School:

Personal Survey

Our goal is to provide you with a meaningful volunteer experience, and in doing so, provide critical support to service areas within our hospital. In the box below, please tell us why you would like to volunteer at IU Health and what you can offer as a volunteer.

If you are under age 18, please enter your date of birth below. Birth date is optional for anyone age 18 or over. *As noted above, all volunteers must be at least age 18 at this time.

Date of birth:

(year optional)

I am at least age 18.:

Availability & Orientation Sign-up

I. Volunteers are scheduled for regular shifts to ensure coverage in the areas in which they serve. Let us know when you would be available to volunteer, keeping in mind that the more you are available, the more options we have to place you in the position you prefer. Remember to choose your preferred location.

II. Under Times Assignment, you will see the next orientation date(s) at West within the next 60 days with openings. Please select the date you can attend orientation and make a note of it. By checking the box, you are signing up for that orientation class. Seating is limited and once all seats are filled, no more applicants can sign up for that date. All applicants are required to attend an orientation before being considered for a volunteer role.

Emergency Contact

Please provide contact information for the person you would like us to reach out to in case of emergency.

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Relationship:

Employer

Please begin with your present or most recent position and account for the last two employers you have had. Include military and temporary experience. Please complete all information for further consideration of a volunteer position. If you do not have employment experience, please list any volunteer/civic/community experience instead.

1

2

Employer name:

First name:

Last name:

Title:

City:

State:

Work phone:

References

Please provide us with the names of two individuals who know you well, and are not relatives. This may be a teacher, employer, group leader, neighbor, coach or coworker. Reference information should be complete enough that we are able to contact your reference via telephone or email.

1

2

First name:

Last name:

City:

State:

Home phone:

Email address:

Relationship:

I Agree

It is the policy of IU Health West Hospital that equal volunteer opportunities be available to all without regard to race, color, gender, sexual orientation, religion, national origin, age, disability, or veteran status.

The receipt of this application does not imply that the applicant will be offered a position as a volunteer. Each question should be answered in a complete and accurate manner since no action will be taken on this application unless all questions are completed.

I certify the information in this application (and in any accompanying documents) is true and complete in all respects. If offered a volunteer position, I understand any omission, false or misleading information in this application, discovered at any time during the employment process or after employment is initiated, may lead to my termination.

I authorize IU Health to conduct an inquiry into the information contained in this application if I am considered for a volunteer position. I authorize my current and former employers and educational institutions to provide information about me. I release all employers and educational institutions or other individuals or entities, which may provide information about me in connection with t his application from all liability for issuing such information. I understand that my volunteer position is conditioned upon acceptable references and a background investigation.

I understand that upon acceptance of a volunteer offer, IU Health West Hospital will require a health assessment which may include, but is not limited to, a health history, immunization update, drug screening test, and TB tests. I hereby consent to such examinations and understand that my volunteer position is contingent upon successful completion of the pre-placement health assessment.

If accepted as a volunteer, I agree to comply with established rules, policies and procedures of IU Health West Hospital. This includes, but is not limited to, those which relate to confidentiality, employment, and the Center for Disease and Prevention Control universal precautions.

I understand any volunteer position with IU Health West will be volunteering at will; my volunteer service may be terminated at any time, with or without cause and with or without notice at the option of IU Health West Hospital or myself. I understand that the terms and conditions of a volunteer position may be changed at any time without notice by IU Health.

I understand I must also sign the Consent and Disclosure Form.

All volunteers under age 18 must have parental consent.

By checking the "I agree" checkbox and submitting my application to IU Health West Hospital I agree that I have read and understand the above.

I Agree