Please complete this application form if you are 18 and older and not currently enrolled in an academic institution. Once you complete the form, check off I Agree, and click the Submit button.


Applicant Personal Information


Level of Education and Major Degree


Emergency Contacts


Volunteer Experience (Most Recent)

List Community affiliation and other Volunteer work.



Availability

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



Worked at BHSF

Have you ever worked for BHSF? If yes, when and where?



Volunteered at BHSF

Have you ever volunteered for BHSF? If yes, when and where?



Family Affiliation at DH

Does anyone in your family currently work at Doctors 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.


If “YES,” please explain all convictions.




Volunteer Conditions

1. I understand that a volunteer at Doctors Hospital is minimally required to work one four hour shift per week. Exceptions will be based on job assignments and determined by the Manager of Volunteer Services. Minimum 100 hours must be completed.

2. I understand that I must complete all Occupational Health Office requirements including a tuberculosis evaluation, which may include a skin test and annual flu shot during the flu season.

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, 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 Doctors 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.