Please complete this application form if you are interested in becoming a Mariners Hospital Volunteer. Once you complete the form, check off I Agree, and click the Continue button.

Applicant Personal Information


Years in Monroe County?


Emergency Contacts


List Community Affiliations & Other Volunteer Work

Please list all your community affiliations and other volunteer work you were involve in the past.


Availability

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


References


Worked at MH

Have you ever worked for Mariners Hospital,or any other entity of Baptist Health?. If yes, when and where?


Volunteered at BHSF

Have you ever volunteered for any BH Organizations?. If yes, when and where?


Family Affiliation at MH

Does anyone in your family currently work at Mariners Hospital?. If yes, who?


Any Convictions

Have you ever been convicted or found guilty (including nolo contendere) for a felony offense? (Conviction
of a crime will not necessarily deny volunteering. A criminal background check is part of the volunteer
application process.)
 YES  NO
If “YES,” please explain all convictions.


Volunteer Conditions

1. I understand that a volunteer at Mariners Hospital is minimally required to work four (4) hours per week, and a maximum of sixteen (16) hours per week. Exceptions will be based on job assignments and determined by the Director or Manager of Volunteer Services.
2. I understand that I must complete a tuberculosis evaluation annually, which may include a skin test.
3. I understand that I must complete a Flu shot yearly during Flu season (10/01 to 03/31).
4. I understand that I may be asked to volunteer days and/or hours other than those specified at the time of
placement.
5. I agree to abide by all the rules, and policies of the Volunteer Services Department/Baptist Health South
Florida. I will attend orientation, complete health office requirements, and complete all necessary training. I will
observe the Volunteer dress code, and the code of ethics, and uphold the Service Excellence Standards. I will
keep all patient information confidential as required by HIPAA and Baptist Health policies.
6. I certify that the information on this application is true and complete to the best of my knowledge. I
understand that any misrepresentation or omission of facts on this application will be sufficient cause for
disqualification of this application.
I give permission for Baptist Hospital to verify any information provided in this application and I authorize my
past references or any other persons to answer all questions concerning my ability, character, reputation, and
previous employment or volunteer record. I release all such persons from any liability or damages resulting
from having furnished such information.