Please complete this application form if you are interested in becoming a Citrus Memorial Health Systems volunteer. Once you complete the form, click the submit button at the bottom.


Demographic Information


References


Emergency Contact


Availability

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



Experience and Skills


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.



Release and Confidentiality Statement

I permit Citrus Memorial Health System (CMHS) to photograph me while performing my volunteer duties with the understanding that these photographs may be used for education purposes, publication, or in advertising and for internal and external public relations at the discretion of CMHS. I do not consider these photographs to be an infringement upon, nor an invasion of, my privacy. I hereby agree to hold harmless and release from any and all liability the hospital, its physicians and its staff with regard to the use of said photographs.


I agree, if accepted, to serve to the best of my ability, to abide by the policies established by the board of trustees of CMHS and by the Policies, Procedures and Bylaws of the Auxiliary. I also grant CMHS permission to conduct a criminal records check on me. Information regarding criminal offenses is not an automatic disqualification for Auxiliary volunteer service. The decision is based on the applicant's ability to perform essential job duties as evidenced by meeting the job specification qualifications and the results of references, background check and personal interview.


Confidentiality Statement


During the course of service at CMHS, you may/will come in contact with or have access to confidential information, records, files, reports, conversations, etc. related to our patients, our business operations and other employees. Your service may also require you to be issued a computer code to enable you to have access to various computer systems. It is the policy of CMHS that all such information is strictly confidential and will only be discussed with and/or divulged to those individuals who have a need to know. Any breach of confidentiality will be grounds for immediate termination of volunteer services that you perform at CMHS.


I understand that by violating this policy on confidentiality, I am also violating Florida laws, which protect an individual's right to privacy and am subjecting myself to personal lawsuits. My signature below indicates that I understand and will comply with this confidentiality policy.