We are pleased that you are interested in volunteering at MedStar Georgetown University Hospital. Please complete the following application for our 2022 Year Round Volunteer Program.


MEDSTAR GEORGETOWN VOLUNTEER OPPORTUNITIES FILL UP QUICKLY SO TIMELY SUBMISSION IS ENCOURAGED!


All responses should be thorough and accurate. Once you complete the form, click the "Continue" button at the bottom.


Please note:


Applications will not be considered complete until both recommender forms are submitted. Recommender forms must be received by the Volunteer Services Office within two weeks of this application submission. We recommend you consult with your recommenders and notify them of your deadline prior to submitting your application to ensure you can submit all materials within the time frame provided.



Volunteer Contact Information


References for Recommendation

Please provide the following information for the individuals who will be submitting recommendations on your behalf. Your recommenders should NOT be relatives, friends, or classmates.


Recommenders should be people who have interacted with you in a professional or academic capacity. Recommenders can be professors, teachers, academic advisors, previous or current supervisors.


Please remember, in order to continue on in this process, both recommendation forms must be received by Volunteer Services within two weeks of submitting this application.



Emergency Contact Information

Please enter two people we can contact on your behalf in case of an emergency.



Demographic Information

The following information is only used to help us get a better idea of the demographic make-up of our volunteers.


The racial categories described in this section are currently used by the US Census Bureau. When making your selection, please choose the racial category you personally identify with.



Educational Background

Please provide information on your education and/or educational experience below. Include degrees/certificates obtained and areas of specialization.



Professional Background

Use the space below to provide information on your present and past professional experience. Be sure to include present and past occupations, professional memberships, as well as any information on your desired future career path (if applicable). Are there special skills you obtained as a result of your past experience that MedStar Georgetown could utilize?



Volunteer Experience

Tell us a little about yourself. Be sure to include information regarding any previous volunteer experience and why you are interested in becoming a volunteer at MedStar Georgetown.


If volunteering is a requirement for school or mandated by a court order, please be sure to also include additional information below.



Availability and Preferences

Volunteers are placed in a regular weekly assignment. Some volunteer assignments are available seven days a week, early morning through late evening.


Indicate the day(s) of the week and time slots you are available to volunteer. Please place a check in any of the boxes below based on your availability.


Providing more availability allows for more flexibility in scheduling you for an assignment.


Tip: It is best to provide your most generous availability, not just the schedules you prefer to work. Doing so may limit your volunteering opportunities. Please note you will only be assigned ONE of these time slots.


*** Do not choose assignments listed as Special Projects from the drop down menu unless the department specifically referred you to apply ***



Volunteer Services Email Policy

It is a requirement that all Active volunteers remain on our list serve and check their emails regularly.


All correspondence from Volunteer Services (urgent hospital information, updates, reminders, special opportunities, etc.) are sent via mass email due to the number of volunteers we manage. This is the main mode of communication utilized by the Volunteer Services department because it enables us to effectively and expediently communicate information to the hundreds of volunteers we employ.


Unsubscribing from mass emails will result in you not getting these messages. Volunteer Services is not responsible for any messages not received due to unsubscribing.


We respect your time and resources and will only utilize your email for urgent matters, volunteer requests and the occasional messages of appreciation for all you do!



Background Check and History

MedStar Georgetown will conduct a criminal records check for all new volunteers 18+. A social security number or Visa/Passport number is required to complete this check. Please be sure to read over the complete Background Check Authorization prior to checking the "I agree" box below. By checking this box, you are:


* Authorizing MedStar Georgetown University Hospital, by and through its independent contractor, Universal Background Screening, to procure a consumer report and/or investigative consumer report on you.


* Releasing MedStar Georgetown, by and through Universal Background Screening, Inc., and any and all persons, business entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands, by yourself, your heirs or others making such claim or demand on your behalf.


Please note: This authorization/release form shall remain in effect for the duration of your employment/service with MedStar Georgetown.



MedStar Georgetown Property Agreement

If accepted, you will be provided a MedStar Georgetown volunteer jacket and identification badge. These items remain the property of MedStar Georgetown and should be returned upon completion of service. In the event one or all items becomes lost or stolen due to negligence on your part, or if you do not return these items within 30 days of you last day of service, you may be subject to pay a fine up to $35.00 to cover the cost of this property.


If your ID badge is lost while you are still actively serving as a volunteer there will be a $10 fee to replace it.


By checking the box below, you agree to all of the terms included in this agreement and are thereby held liable for the safe return of these materials to the Volunteer Services Department.



Volunteer Commitment and Statement

In choosing to apply to become a volunteer at MedStar Georgetown, I am interested in donating my time and effort to MedStar Georgetown University Hospital. I understand that in order to become a MedStar Georgetown volunteer, if I qualify, I will need to complete the application process, including a volunteer orientation that emphasizes key components of the Volunteer Program. (Please refer to the website for the complete list of application requirements.)


In addition, if accepted as a MedStar Georgetown volunteer, I commit to volunteer at MedStar Georgetown University Hospital for a minimum of four hours a week for a total of 100 hours for Year Round Volunteers.



Confidentiality Statement

CONFIDENTIAL INFORMATION:

I understand that the patient expects to communicate with health care practitioners with confidence that none of the information communicated will be released without appropriate authorization. I have read and understand Policy #456 "Confidential Patient Information and Patient Privacy" which outlines my duties under HIPAA regulations (refer to the Volunteer Resources tab of the website).


I understand that the information considered confidential involves all reports within medical records, employee health records, and/or automated information systems concerning examinations, test, treatments, observations, and diagnosis of the patient/employee. It also includes information I learn in conversations with the patient/ employee. I understand that patient demographic information, including all financial data, is private.


I understand that information about physician credentialing, quality improvement, utilization management, risk management, and business information of the organization are to be treated as confidential and may only be released by those authorized to do so.


DUTIES AND OBLIGATIONS:

I understand and agree that as an employee of MedStar Georgetown University Hospital, I must hold certain confidential information in strict confidence, regardless of the method of communication, including but not limited to hard copy, faxed electronically transmitted, oral conversations, or any printed data. This confidence must be kept when performing my duties, as well as during breaks, rest periods and time away from work. I understand that I may not seek access to or release written or computerized confidential information unless my work assignment specifically authorizes me to do so.


I understand that discussions concerning confidential information are not to occur in hallways, elevators, or other public areas where confidential information can be inadvertently overheard by someone not authorized to receive the information. I understand that when I discuss confidential information, I must take precautions so that unauthorized persons will not overhear my discussion.


SYSTEM ACCESS/ELECTRONIC SIGNATURE

I will use my e-mail account/internet access only for business purposes, and I understand that MedStar Health, Inc. management and designated system administrators may read all messages. I understand that the combination of log on and password codes forms my electronic signature. Divulging my password code or that of another, or utilizing the password code of another, or allowing someone else to use my password is not permitted. I will change my password if someone else has knowledge of my password. I will limit system and network usage to functions necessary to perform my job responsibilities. If I leave the work area, I will sign off the application/system to prevent unauthorized access.


CONSEQUENCES

I understand that violation of the terms of this statement may result in disciplinary action up to and including dismissal. In addition, I understand the civil and criminal sanctions that may be imposed by the Department of Health and Human Services (DHHS).


Clicking the "I agree" box below, signifies that you read and understood the contents of this Confidentiality Statement, as well as Policy #456 which further outlines your duties under HIPAA regulations.