Adult and Teen Volunteer Application Form
Please complete this application form if you are interested in becoming a Banner Baywood Medical Center and Banner Heart Hospital volunteer. Once you complete the form, click the submit button at the bottom.
NAME AND ADDRESS
First name:
*
Last name:
*
Middle name:
*
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Rev.
Street 1:
*
Street 2:
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Home (Primary Phone) phone:
*
OK to call me here
Cell phone:
*
OK to call me here
Email address:
*
PERSONAL REFERENCE
First name:
*
Last name:
*
Primary Phone phone:
*
OK to call here
Relationship:
Choose
Co-Worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
DEMOGRAPHIC INFORMATION
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.
Birthday:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Gender:
Choose
F
M
Spouse's name:
School Name:
Have you ever been convicted of a felony or a felony that was reduced to a misdemeanor for sentencing purposes including DWI or DUI? If "yes", please state the offense, locations, date and disposition.
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.
What kinds of email would you like to receive?
Newsletter
Help Wanted
Important Messages
Compliance Alert
Upcoming Event
Volunteer Opportunity
PHYSICAL/MEDICAL BACKGROUND
Do you have any physical or medical conditions that may limit your ability to perform volunteer duties? If yes, please explain:
IN CASE OF EMERGENCY
First name:
*
Last name:
*
Primary Phone phone:
OK to call here
Secondary Phone phone:
*
OK to call here
Relationship:
Choose
Co-Worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
EMPLOYMENT/EXPERIENCE/EDUCATION
Employer name:
*
Please tell us about your previous volunteer work. What are your hobbies or special skills? Are you currently enrolled in High School or College? Where? What are your areas of study or career interest?
AVAILABILITY
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
*
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
Skills:
Admin (Word, Excel, PPT, filing, data)
Bilingual (other)
Bilingual (Spanish)
Cash Handling/Register
Customer Service
Lift up to 10 pounds
Patient Care
Walk of stand for long periods of time
Would you prefer patient contact, or little patient contact? Is there a specific area where you would like to volunteer?
WHY DO YOU WISH TO VOLUNTEER?
Please explain why you would like to volunteer on our campus.
SERVICE WITH BANNER
Have you worked for Banner or volunteered for Banner before? If so, when and where?
COMMENTS
Is there anything else you would like us to know?
VOLUNTEER COMMITMENT TO SERVICE & CONFIDENTIALTY
Believing that Banner Health has a real need for my services as a volunteer, I agree to:
(1) Hold as absolutely confidential all information which I may obtain directly or indirectly concerning patients, doctors, or personnel, and I will not seek confidential information in regards to a patient;
(2) Uphold the mission, Vision, Values, and Service Standards of Banner Health;
(3) Endeavor to make my work the highest quality;
I understand that my services are donated to Banner Health without contemplation of compensation, or future employment and given for humanitatian or charitable reasons. I verify the preceding information on this application is true. I understand that there are many types of volunteer oportunities with Banner Health facilities, and that i will be required to complete an orientation, complete the employee/volunteer health screening, and additional training that service agreements will require.
I Agree
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