Please complete this application form if you are interested in becoming a SOS Health Services of Walla Walla. Once you complete the form, click the Continue button at the bottom.

Thank you!


Contact Information


Demographics

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.



Skills & Experience

Write additional skills we should know about please.



Availability

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



Assignments (the job you want to do)

The following volunteer assignments may currently be available. You may click the assignment names to learn more about that assignment. Use this list to rank your top three assignment choices.



Emergency Contact

In the event of an emergency whom should we notify?




Employer

Please list your current or most recent employer, if applicable.



EMail

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.



Volunteer Information Center

We provide an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.



I Agree

I agree and understand that submitting this application form does not automatically register me as a SOS Health Services of Walla Walla volunteer. I understand that I may be required to attend further training or orientation and that my service may be limited due to schedule or circumstance.


I agree and consent to a state of Washington criminal background check if this should be required for my position.


I understand patient medical and financial information to which I may have access are to be kept confidential and I agree this confidentiality is a legal and moral obligation owed to the patients which will not end after my volunteer service concludes.


I agree this information shall not be disclosed to anyone under any circumstances except to the extent necessary

to fulfill my job requirements. I agree to obtain approval from the medical provider or clinic coordinator before making a disclosure. I understand unauthorized disclosure of patient medical and financial information, records, and data is grounds for disciplinary action up to and including immediate termination of participation as a volunteer.


As a volunteer at SOS Health Services I agree to:


Honor the service commitment I make.

Report on time for any scheduled shift.

Notify my volunteer coordinator promptly if I cannot attend my scheduled shift.

Comply with SOS policies, programs and objectives.

Demonstrate respectful behavior toward SOS Health Services employees and volunteer staff.

Provide services with courtesy and kindness to all patients without discrimination.

Communicate incidents, concerns, or disputes to the clinic coordinator or my program coordinator without delay.


I understand and agree that I am working at all times on a voluntary basis, without monetary compensation or benefits, and not as a paid employee.


I agree SOS Health services has my permission to use my name with any photographs or videos

made of me during my service without obligation or compensation to me and in such manner and at such

times and in such places as SOS Health Services, without restriction, at its sole discretion, shall determine. I agree I will optionally remove myself from photo opportunities in the moment, if I do not want to be photographed.


I understand that SOS Health Services reserves the right to terminate a volunteer's services at any time.

I agree to hold SOS Health Services harmless from any present and future liability and/or damages

for injuries arising from or growing out of this volunteer experience.


By submitting this form, I attest that the information I have provided on the form is true and accurate.