Please complete this application form if you are interested in becoming a volunteer at Highlands-Cashiers Hospital or at the Eckerd Living Center. Once you complete the form, click the Continue button at the bottom for further instructions.

Name and address

First name:

Last name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Cell Phone Number:

Home Phone Number:

Demographic Information

Date of birth:

Education:

T-Shirt size:

Availability

Please indicate the days and times you are usually available to volunteer.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

I would like to serve up to:

hours:

Allow other volunteers to see when I am scheduled

HCH/ELC Experience

Have you ever been employed by/volunteered with Highlands Cashiers Hospital or the Eckerd Living Center? If yes, list position and dates.

Skills

Your check in the boxes below helps us learn more about your background. Please check as many as apply.

Work History

Have you ever been dismissed or forced to resign from any job or volunteer position? If yes, please explain.

Preferences

Put a check beside the volunteer assignment you are interested in. Click on the assignment to get a better description of the volunteer positions available at Highlands Cashiers Hospital and the Eckerd Living Center.

* Assignment Preference:

HCH Acute [Volunteer Services]

HCH Administration [Volunteer Services]

HCH Front Desk [Volunteer Services]

HCH Outpatient Unit [Volunteer Services]

HCH Pharmacy [Volunteer Services]

HCH Registration [Volunteer Services]

HCH/ELC Volunteer [Volunteer Services]

Therapy Cashiers [Volunteer Services]

Therapy Highlands [Volunteer Services]

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Email address:

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Schedule reminders

Vaccination Requirements

All Mission Team Members, including volunteers, must comply with Mission Health's vaccination policies. A vaccination screening appointment with Mission WorkWell will be scheduled as part of the intake process. Please be ready to produce any available immunization records.

Current policy requires:
1. Varicella (chicken pox)Vaccine or proof of immunity
2. Tetanus, Diphtheria & Pertussis (tdap)vaccine
3. Measles, Mumps & Rubella (MMR) vaccine or proof of immunity (those born before January 1, 1957 are exempt from MMR vaccine)
4. Influenza vaccine for the current flu season
5. Tuberculosis screening

Volunteer Agreement Form

Please read through the following statements and acknowledge our Volunteer Agreement by clicking "I agree" at the bottom of the page.

I hereby certify that the answers on this application and any resultant interviews are true and correct, and that any misrepresentation or omission of facts, misleading or false information on my part will be grounds for dismissal as a volunteer.

Acceptance as a volunteer is contingent upon verification of the information submitted on this application, compliance with vaccination requirements and a criminal record check. I, therefore, authorize you make such investigations and inquiries you deem necessary in arriving at a decision.

I acknowledge and agree that I am not obligated, if called upon, to perform the volunteer services herein applied for, and HCH/ELC Volunteer Engagement is not obligated to assign or actively seek to assign volunteer services for me.

I acknowledge that upon completion of this phase of the application I will click continue and be directed to complete the other phases of the application.

I Agree