Volunteer Application Form - INDIVIDUAL

YOU ARE APPLYING TO VOLUNTEER AS A COVID SCREENER. It is expected that you are making application to volunteer as soon as possible.

Errors in the Medical Profession can have dire consequences. Please check your application for capitalization and spelling errors, as well as make sure you have answered all questions before sending. Items marked with an ASTERISK (*) are REQUIRED. When finished please click the continue button at the bottom.

VOLUNTEERS CANNOT USE NICOTINE PRODUCTS AND ALL VOLUNTEERS MUST PROVIDE DOCUMENTATION OF RECEIVING AN ANNUAL FLU SHOT AND ESTABLISH A TB BASELINE AT CHILDREN'S.

Children's of Alabama is committed to ensuring that its online volunteer application process provides equal opportunity for all potential volunteers, including individuals with disabilities. If you believe you need a reasonable accommodation in order to search volunteer opportunities or to submit an application, please contact us by calling 205-638-9695.

REMINDER: We must receive a completed immunization form within 30 days from your date of application. We must have the completed form before you can go to the next step in the process to become a volunteer. If the completed form is not received, then you are not eligible for consideration to volunteer for one year.

Contact Information

Please list your full legal name. If you go by a nickname or a name other than your first name, please list it in the preferred name section.

First name:

Last name:

Middle name:

Title:

Preferred Name, if different from first:

Type:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Preferred Pronouns:

He/Him/His

She/Her/Hers

They/Them/Theirs

Demographics and Personal Information

This information is used only to help us get a better idea of the demographic make-up of our volunteers. Please list the graduation year or anticipated graduation year for the school you list.

In no way will this information be used in volunteer selection. We follow federal employment law in the selection process of volunteers just as human resources does in hiring.

Date of birth:

Gender Identity:

Education:

Marital Status:

Ethnicity:

Source:

School:

Social security #:

Special Accommodations:

Graduation Year or Date Last Enrolled:

Skills & Experience

In which of these areas do you feel you have outstanding skills? Check all that apply.

Availability

Please indicate the days and times you are usually available to volunteer. Most assignments are 3 hours the same day each week.

Assignment Preference

PLEASE REVIEW THE VOLUNTEER OPPORTUNITIES SECTION OF THE WEBPAGES AND MAKE SURE THE ASSIGNMENT YOU PICK IS AVAILABLE AT THE TIME YOU SAID YOU COULD VOLUNTEER. Select up to three choices from that listing. The list that opens here is every volunteer opportunity that has existed, not what is currently available.

Assignment Preference:

1st choice:

2nd choice:

3rd choice:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

City:

State:

Zip:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Employer

Please list your current or most recent employer. If you have worked there for less than three years, please complete item 2 for your prior employer. If you have not been employed, please list any volunteer experience.

1

2

Employer name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Job Title:

Work phone:

Email

OUR PRIMARY METHOD OF COMMUNICATION IS EMAIL. We like to keep volunteers informed with our newsletter, important schedules, and volunteer opportunities by email, however, we 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. MAKE SURE THAT YOU ALLOW IMPORTANT INFORMATION EMAILS; OTHERWISE THIS WILL BLOCK ALL CONTACT WITH YOU.

Email address:

What kinds of email would you like to receive?

Important Information
Published 6 times a year with information regarding activities of our volunteers.

Recruitment Appeals
When a new volunteer position is created, or a new need in a current position, we may request volunteers consider the assignment.

General Messages
General messages include information important to you as a volunteer. These messages may also include information about gift shoppe on main sales, and special events for volunteers. It will also be used to keep you informed of any weather related events.

Newsletter
This will be an item that is of upmost importance for all volunteers.

Reminder
This is an item that you may need to take action on.

Checklist Reminder
This is a reminder when items are needed to be completed to remain in good standing - for example annual TB skin test.

Urgent Message

Checklist reminders
This is a reminder when items are needed to be completed to remain in good standing - for example annual TB skin test.

Physician Contact

First name:

Last name:

Title:

Work phone:

Health Data - YOU MUST COMPLETE THIS SECTION

Please list any medications or food to which you are allergic. YOU MUST LIST ALL PRESCRIPTION DRUGS YOU ARE TAKING. Also list any chronic medical conditions you may have (e.g., high blood pressure, diabetes, etc.). List if you have ever had a positive TB skin test or received the BCG vaccine that shows false positive TB skin tests. You may also fully describe your need for special accommodation here.

If you have nothing to list, please answer with "I do not take any prescription drugs and I have nothing to list."

Criminal History

Have you ever been convicted of a felony or misdemeanor (including pleading guilty and nolo contendere)? Falsification of this or any other information on the application is grounds for immediate dismissal.

No Criminal History:

Yes Criminal History:

If, yes, please explain:

Connection - YOU MUST COMPLETE THIS SECTION

Do you have a connection to Children's of Alabama? Have you ever volunteered at Children's before? If you have, please give the year of your last service.

If you or a family member is either an employee or volunteer, please list the name and department.

Please answer none, if you don't have a connection to Children's.

YOU MUST COMPLETE THIS SECTION.

Year of prior service at Children's:

If you have family members who are employees or volunteers, please list their names and department of service. If you do not, please list "none." You must answer this question for your application to be considered.

I Agree

I certify the statements made on this application and any addendum are true and complete to the best of my knowledge. I understand that any false statement or omission of any statement on this application, and any addendum, can be sufficient cause for rejection of my application or for dismissal or other discipline that is appropriate when any false statement or omission is discovered or confirmed subsequent to my volunteering.

I understand that, prior to my being accepted as a volunteer, Children's of Alabama will perform, or request that a third party perform, a background investigation to determine my suitability for volunteering. I authorize Children's of Alabama to have written access to any records concerning my criminal history, education, and employment background. I understand that if any inquiry is made, all information as to its nature and scope will be supplied upon written request.

I understand that if Children's of Alabama decides to make me an offer to volunteer that such offer is conditioned on my satisfactory completion of pre-screening, where I must be nicotine free. I also understand that as a volunteer I MUST receive an annual flu vaccine and establish a TB baseline at Children's.

I will consider confidential all information which I may hear directly or indirectly within Children's of Alabama concerning patients, physicians, or any member of personnel. I will not seek information regarding patients. I pledge to be dedicated to the mission of Children's of Alabama, to abide by the Volunteer Services Department policies and procedures.

I understand that volunteering is an unpaid position and that I am not entitled to any salary or benefits. I further understand there is no connection between volunteering and employment.

Children's of Alabama is authorized to take my picture at any time, and may use it in promotional materials, marketing, newsletters and for identification purposes.

I am confirming that I have read the above information, and I agree to abide by this information and I am responsible for knowing it.

I Agree