Volunteers are vital in helping to assure that quality health care is available to those living in the communities we serve. One way our volunteers assist is by helping the Beebe Healthcare Foundation through fundraising activities.


Once your application is received, you will be contacted to schedule an orientation session. At the orientation, opportunities will be discussed with an attempt to match your talents and time availability. Necessary paperwork will need to be completed to register you for that orientation.


Personal Information

Please provide the following information so we can contact you. Please note that you must be at least 16 years old to volunteer for the Foundation.



Spouse/Partner Information

Please provide the following information, if applicable.



Availability

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



Committee Interests

Please choose any committees you might be interested in.



Personal References

Please list two (2) references who are not relatives.



Emergency Contact Information

Please provide the name, address and telephone number of someone that we may contact in case of an emergency.



Why Beebe?

We realize you have a choice in where to volunteer and would sincerely like to know why you would like to help us. Please explain.



ALL PERSONS SEEKING VOLUNTEER PLACEMENT:

WITH A HEALTH CARE FACILITY ARE REQUIRED TO READ AND SIGN THIS ACKNOWLEDGEMENT. THIS IS ACCORDING TO THE STATE OF DELAWARE REGULATIONS: Special Employment Practices Regulations Relating to Health Care Facilities (19 Del. C. 708 and 11 Del. C. 8563 and Adult Abuse Registry Check (11 Del. C 8564)

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Have you ever been involved in the substantiated abuse or neglect of children or adults under the laws of Delaware or any other state in the United States? Please answer YES or NO. If yes, please explain:



Disclaimer

Are you, or have you ever been, subject to exclusion or debarment under Federal law, or designated in a state abuse registry (including any nurse aid registry) as having a finding concerning abuse, neglect, mistreatment or misappropriation of property? Please answer YES or NO. If yes, please explain:



CAREFULLY READ THIS PRIOR TO SIGNING BELOW:

I authorize a full release for Beebe Healthcare to obtain information from my current and/or previous employer(s). I attest that the information I have given on the application (and accompanying resume, if any) represents a full and complete disclosure of information about my employment history, and that all information contained in the volunteer application is true and complete to the best of my knowledge and belief. I understand that failure to provide a full and complete disclosure is a violation of the law and, as such, is subject to civil penalties in the form of a fine. I understand that any false or misleading representation or omission made on the application during the volunteer interview process may disqualify me from further consideration for volunteering and may result in discharge even if discovered at a later date.


I understand that volunteering is conditional upon successfully passing the Adult, Child Abuse Registry and Criminal background checks. I understand that should my position require it, Beebe Healthcare may obtain a copy of my driving record.


I understand that my volunteering is at-will which means that I may terminate the volunteer relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for a written agreement signed by an administrative representative of this facility and notarized.