Ascension Saint Thomas Hospital West Adult Volunteer Application

Thank you for your interest in volunteering with Ascension Saint Thomas Hospital West. Please review the requirements below, complete the form, and click the submit button at the bottom.

VOLUNTEER REQUIREMENTS:

* Volunteers must be 18 years of age or older and completed high school
* Be willing to make a minimum commitment of one four-hour shift per week with a minimum of 20 hours per month
* Complete mandatory Volunteer General Orientation upon acceptance to the Volunteer Program

ALL APPLICANTS SHOULD CONSIDER THE FOLLOWING:
1. Are you involved with other organizations, hobbies, work commitments, or have a changing academic schedule that might prevent you from keeping your commitment?
2. Would your schedule allow you to volunteer for four months with no more than two absences?
3. Are you available to volunteer once a week, same day and same time every week?
4. Do you have consistent and reliable transportation?
5. Are you mature, responsible, outgoing, friendly, proactive and willing to engage with people as you help them?

BECOMING A VOLUNTEER:
1. Fill out the Ascension Saint Thomas Hospital West Adult Volunteer online application or request a printed copy.
2. After your completed application and availability has been reviewed, we will contact you to schedule an interview.

IMMUNIZATION REQUIREMENTS:

Prior to volunteering you will need to complete Ascension Saint Thomas (AST) immunization requirements. You will be responsible for obtaining those that may be missing. All immunizations must be completed before you are allowed to begin volunteer service.

* "T-Spot" TB Test (blood draw)
* Urine Drug Screen
* MMR Titer (or provide proof of MMR Vaccination)
* Flu Shot (required only during flu season, typically beginning December 1st, ending March 31st)

HEALTH INFORMATION REQUIREMENTS:

Upon acceptance to the AST Volunteer Program, contact and other important information will be provided to schedule and prepare for your appointment with the AST Hospital West Employee Health Department.

TRAINING:

If accepted as an Ascension Saint Thomas Hospital West Volunteer, you will be required to complete Volunteer General Orientation. This is required for participation in the Volunteer Program. Once you have been oriented, you will be scheduled for your first day on which you will receive your volunteer ID badge and uniform, learn to sign in/out, and begin orientation to your assigned service area.

PERSONAL INFORMATION:

Please provide the information below as accurately as possible.

**INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED**

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

Social Security Number:

* Convicted of/or pled guilty to a crime?:

Yes

Tell us why you are interested in becoming a volunteer and how your skills and ability would benefit the mission and ministry of Ascension Saint Thomas:

DEMOGRAPHICS:

Date of birth:

Age:

Gender:

EDUCATION:

Level of Education:

Current School Attending:

Major/Degree:

Still in School? When will you graduate:

WORK HISTORY:

If you have worked in the last seven years, please provide information about your employment history.

If currently employed, list your title:

1

2

Employer name:

Street 1:

City:

State:

Zip:

Work phone:

SERVICE AVAILABILITY:

Volunteers are asked to make a minimum commitment of four months with 20 hours per month unless otherwise specified by service area. Please select your days of service by interest and availability below.

SERVICE PREFERENCE:

In regards to volunteer service, are you seeking direct patient contact, prefer working with the general public, or skilled in organization and clerical tasks?

Are there working conditions or settings that you must or would like to avoid? If so, please explain.

EXTRACURRICULAR ACTIVITIES:

Please list any community or school affiliations, previous volunteer experience, and any work experience you may have.

EMERGENCY CONTACT(S):

1

2

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Relationship:

VOLUNTEER STATEMENT AND PLEDGE (please read):

I affirm that the information I have provided in this application is true and complete to the best of my knowledge. I understand that any falsified, misrepresented, incomplete or omitted information may disqualify me from consideration for volunteerism or result in my dismissal from volunteerism.

Understanding that Ascension Saint Thomas Hospital West has a valid need of my services as a Volunteer:

• I understand that I must complete all necessary Employee Health screenings (including TB testing, drug screen, and proof of MMR vaccination) and orientation requirements prior to beginning my service as a volunteer with Ascension Saint Thomas Hospital West.

• I authorize Ascension Saint Thomas Hospital West to request and receive any information and records concerning my criminal record history.

• I will consider as confidential, all information which I may hear directly or indirectly concerning a patient, physician, nurse, or any other person related to the hospital, and will not seek information in regard to the patient.

• I will be punctual and conscientious in the fulfillment of my duties and accept supervision graciously.

• I will conduct myself with dignity, courtesy, and consideration.

• I will represent the Volunteer Program in a positive manner by practicing service excellence, respecting all others, smiling, and using appropriate behaviors at all times.

• I will take any problems, criticisms, or suggestions, to the Volunteer Services Coordinator.

• I will endeavor to make my work professional in its quality and I will uphold the traditions of high standards of this hospital and will interpret them to the community at large.

I Agree