Please complete this application form if you are interested in becoming a Nightingale Volunteer at CHI St. Joseph Health volunteer. Once you complete the form, click the submit button at the bottom.


Requirements to Volunteer as a Nightingale

To ensure your commitment and education level meets our requirements, please acknowledge that you have reviewed and will be able to comply with the following:

1. Education: Minimum requirement – RN licensure: active, inactive, or retired


2. Experience: Preferred 3-years hospital, health clinic, medical office experience, but recent licensure

is accepted.


3. Hours of Work: Minimum 4-hour shift once per week (flexible times)


4. Length of Commitment: Minimum 1 year, not necessarily consecutive. Willing to work with each applicant on individual basis.


5. Training: Attend general volunteer orientation, portion of RN orientation (scheduled bi-weekly on Wednesdays 7:30 am - 10:30 am), on-line orientation modules, and department specific orientation (times flexible).



Contact Information


Demographic Information

The following information is required to process your application. Date of birth information is required to process your background screening. This information will be held in the strictest confidence.



Education

Please list the following: school attended for RN licensure, degree earned (associate, bachelor or masters), date of graduation, license number, status of license (active, inactive or retired).



Credentials

Please list the following: your license number, state issuing license, current status of license (active, inactive or retired), if active license date of expiration.



Skills & Experience

Please outline your areas of nursing practice experience.



Skills Assessment

As we prepare to look for your ideal volunteer opportunity, take a few minutes to assess your skills.

What are you good at?

What comes easy for you?

What aspects of your professional life might be assets to our organization?

What personal or interpersonal talents do you have?

Check all that apply.



Availability

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



Assignment Preference

Nightingale volunteers may be placed in any of our nursing areas (Oncology, Telemetry, Medical, Sugery/Orthopedics, Nursery, Pediatrics, Post Partum, Critical Care, Labor & Delivery, and Rehab). If you have a preference, based on your nursing experience, please indicate that here.



Emergency Contact

In the event of an emergency, whom should we notify?



CHI St. Joseph Health Volunteer Information Center

We provide an online "Volunteer Information Center" where volunteers may check their schedules, find out how many hours they have, update their information, and receive messages. **Note** an email address is required to have access to this system.



Background Check:

We consider the safety and security of our patients to be of the utmost importance. Applicants must complete a background screening for criminal histories by state and/or federal agencies. Persons who have been convicted of any felony offense or misdemeanor offenses involving drugs, adult/child abuse, assault or any violent behavior are not eligible to volunteer at CHI St. Joseph Health. There are no exceptions. By checking, I agree, at the end of this application, you consent to the background check and attest that you have not been convicted of a felony or misdemeanor as stated above. If you have ever committed, been convicted of, pled guilty to, or pled nolo contendo to, a felony or misdemeanor, please explain.



I agree

I understand and agree that submitting this application form does not automatically register me as a CHI St. Joseph Health Nightingale Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies, completion of orientation requirements and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate and I have not been convicted of a felony or misdemeanor involving drugs, abuse and/or an act of violence.