Ascension Saint Thomas Hospital Midtown Adult Volunteer Application

Thank you for your interest in volunteering with Ascension Saint Thomas Hospital Midtown. Please review the requirements below, complete the form, and click the submit button at the bottom. Please note that open volunteer positions are limited. If you are chosen for an interview, it will be for available open positions only.

VOLUNTEER REQUIREMENTS:

* Volunteers must be 18 years or older and have completed high school.
* Be willing to make a minimum commitment of one four hour shift per week with a minimum of twenty hours per month.
* Attend a mandatory Volunteer Orientation to be scheduled upon acceptance.

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 six months with no more than 3 absences?
3. Are you available to volunteer once a week, same day and same time every week?
4. Do you have consistent transportation?
5. Are you mature, responsible, outgoing, friendly, proactive and willing to engage people as you help them?

BECOMING A VOLUNTEER:
1. Fill out the Ascension Saint Thomas Hospital Midtown Hospital 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 the Volunteer program immunization requirements. You will be responsible for obtaining those that may be missing. All immunizations must be completed by the time you attend your General Volunteer Orientation

* Two TB skin tests
* Drug Screen
* MMR
* Varicella Titer
* Flu Shot (required only during flu season typically beginning Dec. 1 ending March 31)

TRAINING:

If accepted as an Ascension Saint Thomas Hospital Midtown Volunteer, you will be invited to attend a Volunteer 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 have your ID badge made, select your uniform, learn to sign in/out, and be oriented to your service area.

HEALTH INFORMATION REQUIREMENTS:

Once you have been accepted to the program, you will need to contact the Ascension Saint Thomas Hospital Midtown Employee Health Department to schedule your TB test, drug screen, and flu shot (as applicable). Information to be given at your interview.

PERSONAL INFORMATION:

Please provide the information below as accurately as possible.

**INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED**

First name:

Last name:

Middle name:

Title:

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 Saint Thomas Health:

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 PREFERENCE:

In regards to volunteer service, are you seeking 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.

SERVICE AVAILABILITY:

Volunteers are asked to make a minimum commitment of six months with 20 hours per month unless otherwise specified by area of service. Please indicate the days and times you are usually available to volunteer.

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 AGREEMENT 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 Midtown 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.

• I authorize Ascension Saint Thomas Health Services 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