Volunteer Application Form
Please complete this application form if you are interested in becoming a Reedsburg Area Medical Center volunteer. Once you complete the form, click the submit button at the bottom.
Name and Address
First name:
Last name:
Street 1:
City:
State:
Choose
CO
FL
WI
Zip:
Home phone:
OK to call me here
Cell phone:
Email address:
Emergency Contact
First name:
Last name:
Home phone:
Cell phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
Demographic Information
You may provide the following optional information. It is used only to help us get a better idea of the demographic make-up of our volunteers.
Date of birth:
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
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
(year optional)
Gender:
Choose
Female
Male
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
School:
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
Please indicate what your interests are for volunteering at RAMC.
Personal Experience
Please share with us any previous volunteer experience you have and why you think you'll be a good fit for RAMC.
Volunteer Selection Policy
Our policy is to select and train the best-qualified individuals without regard to race, color, religion, creed, sex, national origin, age, disability, citizenship, veteran or marital status.
Volunteers are placed according to their interests as much as they match the needs of the medical center.
The information provided in this application is true in all respects, without any willful omissions. I understand that if I am selected as a volunteer, any false or misleading statements
on this or any company document may result in immediate dismissal without notice regardless of when the false information is discovered.
I certify that the answers on this application are, to the best of my knowledge, true and that I have not knowingly withheld any pertinent information.
(Please type your name to signify your agreement)
Application Agreement
I agree to:
__ complete the volunteer orientation and train until I am competent to perform the required duties.
__ complete a Criminal Background Check, which regardless of the results, will remain confidential
__ complete annual health and educational screenings as deemed necessary.
__ comply with all the rules and regulations of RAMC.
__ Understand that I may be dismissed from my duties for willful wrongdoing or negligence and/or performing duties outside of my service guidelines.
__ notify the Volunteer Coordinator or immediate supervisor as soon as possible when I have scheduling changes.
COVID-19 Return to Service Volunteer Agreement
This agreement provides new and returning volunteers with a method of completing required documentation related to volunteering anywhere on the Reedsburg Area Medical Center campus - including Resale Beyond the Expected (these combined facilities are hereby referred to as RAMC), while under COVID-19 safety guidelines as provided by Sauk County Public Health and RAMC Infection Prevention. Each volunteer must review and agree to the safety requirements and expectations listed below in order to volunteer:
__ I acknowledge that the requirements of this agreement are for my own safety, as well as that of patients, visitors, other volunteers, and employees of RAMC.
__ I am aware that I must follow all safety and hygiene protocols that have been implemented by Reedsburg Area Medical Center.
__ I agree to wear a facemask upon entering and while on premises of the medical center until such time that it is determined by Infection Prevention that facemasks are no longer needed at RAMC.
__ I agree to be screened at the RAMC entrance with questions and temperature taken each time I enter RAMC.
__ I agree to follow the 6 feet social distancing guidelines while in my assignment and traveling through RAMC.
I Agree
Continue