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:

Zip:

Home phone:

OK to call me here

Cell phone:

Email address:

Emergency Contact

First name:

Last name:

Home phone:

Cell phone:

Relationship:

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:

(year optional)

Gender:

Education:

School:

Availability

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

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