Thank you for your interest in joining the volunteer team at the Free Clinic of SW Washington. This application is for HEALTH PROFESSIONALS whose credentials are regional, national, or otherwise not with the WA State Dept. of Health. Please provide your information as completely as possible. Health Professionals that have out-of-state licenses are required to fill out a WA state attestation stating that they can only volunteer up to 30 days in a calendar year for the Free Clinic.
After submitting your application, please allow TWO WEEKS for processing. You may then be contacted to arrange an interview or be placed on the waiting list depending on the position you are applying for.
Please note that completion and return of the volunteer application does not guarantee acceptance as a volunteer. All applications will be reviewed, verified, and kept on file. Please ensure that you enter a valid email address as this is a primary means of communication with applicants.
* indicates a required field.
Please provide your full legal name so that we may verify your professional credentials online.
Volgistics Volunteer Alerts sends reminders, alerts, and custom messages from System Operators and Coordinators. Use this section to opt-in and opt-out of text messaging (also known as "SMS"), and initially set how you would like to receive messages. Your messages can be delivered as emails, text messages, or none. You can change this at any time through VicNet. View supported phone carriers.
Message and Data Rates May Apply. For help or information on this program send "HELP" to 28344. You can send "STOP" to 28344 at any time to opt out. For additional assistance, call 888-891-6978 or click here. Message frequency based on account settings. Messages are not guaranteed to be delivered. All messages will be sent by email until you respond "YES" to the welcome text message sent after the application form is submitted. Message preferences can be changed in VicNet on the Account tab.
If you are not employed, please list your last employer and last date worked.
Please select (or describe) your license type, the state in which you are licensed and/or provide the contact information for the credential verifying agency or national organization.
The Free Clinic insurance policy covers all volunteers with the EXCEPTION of Dentists and Physicians. Washington Healthcare Access Alliance (WHAA), provides free malpractice insurance for all health professional volunteers & helps with the cost of licensing for those who only use their license to volunteer. If you need or would prefer to have separate insurance, please go to the WHAA website https://www.wahealthcareaccessalliance.org/ or contact the Free Clinic at (360)450-3044.
Please select your preferred assignment and the days/times which you are generally available to volunteer. Our clinic hours are: Mon, Tues, Weds, Thurs, Fri - 9AM to 12PM + Tues, Weds, Thurs 1PM to 4PM. If you are a specialist, will you provide care only in your specialty? Please use the notes section for additional details.
Some volunteers are associated with a particular service group (Friends of the Free Clinic) or service day (Kaiser MLK Day). Please let us know if you are, or if you would like to start a group effort from your clinic.
Note: A government (official) Photo ID is required before beginning volunteer service.
Please list one professional and one character reference below.
Please tell us a little about yourself, why you wish to volunteer with Free Clinic, any specific skills you have, and note any relevant volunteer experience.
In case of emergency, who should we contact on your behalf?
Please disclose any criminal convictions and/or any action(s) against your professional license and explain with the text field below. This disclosure does not automatically preclude volunteer service here but must be reviewed by FCSW. By submitting this application you are giving permission for FCSW to conduct a criminal background check.
CRIMINAL BACKGROUND CHECK
As of July 1st, 2010, any new volunteer applicants must consent to, and pass, a criminal background investigation before being accepted as Free Clinic volunteer. The Vancouver School District, a Free Clinic partner, and will implement these checks for the Free Clinic, according to their own policy and procedure guidelines. Results of these checks will be reviewed by the Volunteer Manager for a final determination of volunteer suitability.
OREGON RESIDENTS
A $33 processing fee will be collected prior to screening of applicants from Oregon in order to access the Oregon State Criminal Background Check database.
EXCEPTIONS
Health Professionals who are licensed in Washington State are exempt from this procedure because the state conducts a criminal background check before issuing a license.
Is there anything else we should know about you?
Please use this space to provide any additional information, or questions you have.