Ivinson Memorial Hospital Volunteer Application

Ivinson Memorial Hospital appreciates your interest in our volunteer program. Volunteers play a vital role as a part of our IMH team and enhancing the patient experience.

Ivinson Memorial Hospital and the Foundation are committed to embracing the talents of individuals who strive to further our mission to provide integrated and innovative healthcare. We are committed to providing equal opportunity for all applicants. Decisions are made based upon fulfilling required qualifications and being able to satisfy volunteer interest with available placement opportunities.

Qualifications for all volunteers:

• At least 18 years of age.

• Honest, reliable, and able to be professional in all interactions.

• Friendly, customer-service oriented, and possess effective communication skills.

• Physically able to work independently with or without accommodation; some services require sitting, standing, or walking for extended periods of time.

• Be willing to comply with the volunteer dress code and hospital standards of appearance.

Requirements for volunteering:

• Submit an application.

• Attend an interview with Volunteer Services.

• Complete the following: (at no cost to you)

o Criminal background check

o Drug screen

o TB test

o Influenza vaccination during flu season.

• Complete orientation process and routine training.

If you have any questions, please feel free to contact our Volunteer Coordinator, Sharleen Castle at (307) 755-4513.

Contact Information

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Date of birth:

Emergency Contact

First name:

Last name:

Home phone:

Cell phone:

Educational Background

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Education:

School:

Please describe any skills which might be utilized by our volunteer program.

Volunteer Experience

Have you volunteered in the past? If so, where did you volunteer, and why did you stop volunteering at this organization?

Volunteer Interests

Assignment Preference:

Cancer Center: Assisting Staff & Patient Support [Options\Cancer Center]

East Entrance: Greeting, Way Finding & Staff Support [Options\East Entrance Medical Offices]

Gift Shop: Sales & Shop Support [Options\Gift Shop]

Quality Management: Patient and Family Engagement Council [Options\Quality Management (currently unavailable)]

Radiology: Unit Support [Options\Radiology]

Surgery Waiting Room: Family Support & Assisting Staff [Options\Surgery Waiting Room (currently unavailable)]

Why would you like to volunteer at Ivinson Memorial Hospital? Have you volunteered with us or worked with us before? If so, in what department?

Availability

Volunteer needs can vary depending on placement. Please list which days and what hours you are available.

References

1

2

First name:

Last name:

Cell phone:

Relationship:

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Schedule reminders

Checklist reminders

Agreement

I understand that:

• Volunteer opportunities are not clinical internships or rotations.

• Being a volunteer does not guarantee employment at Ivinson Memorial Hospital.

• Being a volunteer is at-will and I will not be paid for my services.

• Ivinson Memorial Hospital reserves the right to terminate my volunteer status if I do not comply with hospital policy.

• I shall uphold the mission and vision of Ivinson Memorial Hospital at all times.

• I understand that I am held to certain behavioral and performance standards as outlined in IMH policies which can be accessed by me at any time upon request.

I certify that I understand the policies and procedures of being a volunteer at Ivinson Memorial Hospital.

I Agree