Volunteer Application

2986 Kate Bond Road

Bartlett, TN 38133-4003

901-820-7150

Dear Potential Volunteer,

Thank you for your interest in volunteering at Saint Francis Hospital-Bartlett. Your willingness to serve in this capacity is truly appreciated. Becoming a volunteer for our hospital is a three-step process.

FIRST, please complete the following sections that include an application and confidentiality agreement. Upon the successful completion of the first step, you will be contacted to schedule an interview. During the interview, adults will be asked to sign a form giving us permission to run a criminal background check.

SECOND, all applicants must be cleared by Employee Health. This includes a blood test and two TB skin tests. There is no charge for the pre-placement testing. When you report to Employee Health you will be asked to complete a short medical questionnaire.

THIRD, all volunteers are required to attend an orientation class. After your application is cleared by Employee Health, you will be contacted to schedule an orientation that is convenient with you.

LAST, a smock for ladies or jacket for men can be purchased approximately $30. Women wear white pants, white top and white shoes. Men wear dark pants. Jeans and open-toed shoes are not permitted.

A summer teen program is available to 16 and 17 year old students. Specific requirements for admission to this program will be discussed prior to your interview.

We are very happy that you are interested in becoming a member of our volunteer family at Saint Francis Hospital-Bartlett. If you are unable to identify a volunteer opportunity among those listed, we will be pleased to find you just the right spot to utilize your individual gifts and talents. We are hopeful that your service will be personally rewarding and fulfilling.

Sincerely,

Will Lowes, Director
Volunteer Services

Contact Information

First name:

*

Last name:

*

Middle name:

Title:

*

Nickname:

Street 1:

*

Street 2:

City:

*

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Other phone:

OK to call me here

Email address:

Date of birth:

*

Spouse's name:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

*

Last name:

*

Title:

Street 1:

*

Street 2:

City:

*

State:

*

Zip:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Other phone:

OK to call here

Relationship:

Employer

Please list your current or most recent employer, if applicable. If retired, list your last place of employment.

Employer name:

Street 1:

Street 2:

City:

State:

Zip:

Work phone:

OK to call here

Other phone:

OK to call here

If you are retired---What career area did you retire from?

Demographics

Gender:

*

Education:

*

Marital status:

*

High school:

*

College:

Social security number:

Availability

Please indicate the days you are available to volunteer. We ask volunteers to commit to a minimum of four hours per week for a minimum of six months.

Email

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.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

General Announcements

Conviction

In the box below, please answer "yes" or "no" to the following question: Have you ever committed, been convicted of, pled guilty to, or pled nolo contendo to a felony or misdemeanor? If you answered yes, please explain. NOTE: Conviction of a crime is not necessarily grounds for disqualification.

Respond here:

Hospital Policies

Confidentiality Agreement Policy

I understand that all patients and residents of Saint Francis Hospital – Bartlett are entitled to privacy, and expect me not to share facts about them or their illness with others. I further hereby promise and agree to abide by the rules and regulations set forth by Saint Francis Hospital – Bartlett, that I will perform my duties with professionalism and courtesy, and that any information that crosses by attention, whether written, oral, and/or by sight, will be held in strict confidence and will not be relayed to anyone other than the appropriate hospital staff and personnel. I understand that any breach of this Confidentiality Agreement my result in the termination of my volunteer services at Saint Francis Hospital – Bartlett.

.

Nail Policy

Saint Francis Hospital – Bartlett is committed to ensuring a safe and healthy work environment. We require, as a condition for employment or volunteering, that our staff have short, clean and healthy nails. Nail polish, if worn, should be of a clear and light color, translucent and free of cracks or chips. Artificial nails, and nail jewelry, or decorations are not allowed.

Remuneration Policy

I understand that volunteers receive no remuneration for service provided. I also understand that my volunteer service is no guarantee of future employment with Saint Francis Hospital – Bartlett.

Service Policy for Adults:

I am willing to commit to a least 104 hours of service with Saint Francis Hospital – Bartlett. I understand that volunteers are generally required to perform a minimum of four hours of service weekly for at least six months.

Service Policy for Teens:

I agree to commit to my service at Saint Francis Hospital - Bartlett. I understand that I must follow the absences policy and am not allowed to arrive excessively early or stay excessively late past my scheduled volunteer time.

By submitting this form, I attest that the information I have provided on the form is true and accurate and that I agree to abide by all hospital policies.

I Agree