Please complete this application form if you are interested in becoming a Northside Hospital Cherokee VolunTeen. Once you complete the form, click the submit button at the bottom.


Name and address


Emergency Contact

In case of an emergency, who should we contact?



Education

What high school do you currently attend?




High School and Community Involvement

What clubs or activities are you involved with at your high school or within your community?




Employment

Do you have a part time job? If so where?



How did you hear about our volunteer program?


Why do you want to be a NHC VolunTeen?

Please must submit a 50-100word paragraph. The paragraph needs to tell us why you would like to volunteer, what you expect to learn/gain from volunteering and why we should choose you for our program



Northside Hospital Cherokee Volunteer Agreement

I understand and agree that submitting this application form does not automatically register me as a Northside Hospital Cherokee volunteer and that there are certain qualifications I must meet. These include the acceptance and agreement of established volunteer policies and procedures; completed TB skin test; completed School Counselor and Record Release Form; Required Immunizations and Record; VolunTeen interview and orientation attendance; before I may begin volunteering.


I certify that all information provided in this application is true and correct to the best of my knowledge. I understand that any falsification (or significant omission) of information requested herein will be considered sufficient cause for terminating my membership with Northside Hospital- Cherokee Auxiliary. I hereby elect and agree to be covered by Northside Hospital’s Worker’s Compensation Program for any accident or injury sustained during the course of my volunteer service to NSHC. I acknowledge that I am not considered an employee of Northside Hospital-Cherokee for any other purposes and am not entitled to any of the other benefits available to employees.


VolunTeen Agreement:


(1) I agree to volunteer for at least a minimum of 28 hours and at least 7 weeks of service (You will be required to work the same assignment on the same day, and time for at least 7 weeks out of the 9 week program). I understand that failing to fulfill this commitment will result in my not being allowed back the following summer and not receiving a certificate of hours served (including no verification that you have volunteered).

(2) I agree to treat all patients, visitors, staff and other volunteers with courtesy, respect and without regard to race, religion, sex, age or national origin – embracing cultural differences.

(3) I will always demonstrate appropriate use of language, have a positive attitude and maintain professional behavior.

(4) I will adhere to my schedule and always notify the Department of Volunteer Service in case of my absence.

(5) I will wear my photo identification badge and official uniform at all times when volunteering in any Northside Hospital Cherokee service area.

(6) I will abide by the Northside Hospital Cherokee Volunteer Services Department cafeteria benefit – a free snack/meal for every 4 hours of volunteered service not to exceed $6.00. This snack/meal must be taken after your shift.

(7) I will return my badge at the end of the program.

(8) I agree to comply with the requirements, rules and regulations as determined by the Northside Cherokee hospital, not limited to but including HIPAA compliance and confidentiality.

(9) I will be self-motivated. I will be anxious to learn all that I can about the hospital. If I have any questions or doubts, I agree to ask someone who can help me.

(10) I will always exceed customer service expectations to help Northside Hospital Cherokee deliver world-class healthcare.

(12) I have read, understand and agree to support the mission and vision and values of Northside Hospital Cherokee.

(13) I will not use my cell phone to talk, text, or surf the net during my VolunTeen shift. In case of an emergency, I will go to the volunteer office to make any necessary calls.


I ACKNOWLEDGE THAT - I have read and understand the VolunTeen Agreement for the Northside hospital Cherokee 2017 Volunteen Program, and that I will abide by the rules and policies as outlined.