Please complete this entire application to be considered for a volunteer position at any UC Health location (UCMC, West Chester Hospital, or Daniel Drake Center). Any fraudulent information on this form will constitute grounds for disqualification or dismissal.


Please note that in order to be considered for a volunteer position, you must be willing to commit to a minimum of 50 hours over a 6-month period.


Additional requirements for volunteering include:

• Provide SSN for background check (some locations may require fingerprint)

• Complete a Volunteer Orientation

• Provide proof of annual flu shot (winter months only)

• 2-step TB test, provided by the hospital



It is the policy of UC Health to provide equal opportunity to all volunteers and applicants without regard to race, color, religion, gender, national origin, age, disability, genetic information, ancestry, military status, sexual orientation or any other status protected by applicable law.


Contact information


Preferred Site

Which location(s) do you wish to serve? (check all that apply)


Daniel Drake / Bridgeway Pointe:  Post Acute Care and Rehabilitation Center / Assisted Living Facility - located on Galbraith Road near I-75

UC Medical Center:  Hospital and Level 1 Trauma Center - located in Clifton, near the UC Campus

West Chester Hospital:  Hospital and Level 3 Trauma Center - located in West Chester




Areas of Interest

Please check any positions you would be interested in. Click on a position for a job description.



Availability

Check all times you are available.



Tell Us More

Please tell us more about why you would like to volunteer, and what you hope to achieve through this experience. Include any special skills that you feel would be useful in volunteering.



Previous Hospital Experience

Tell us about any previous volunteer or employment experience you have with a hospital or other healthcare facility, i.e. nursing home.



Friends & Family at UC Health

Any friends or relatives who are employed or volunteer at UC Health (including UCMC, West Chester Hospital, Drake, etc)? Please give name and position.



Health Information

Any health limitations?



Employment

List current/last place of employment



Personal References

Please list 3 personal references who are not relatives.



Emergency Contact

In the event of an emergency whom should we notify? Please provide at least one phone number.



Volunteer Commitment

Please read the following statements carefully. By typing your name in the box below, you state your agreement to the following:


As a Volunteer at UC Health:

1. I will be punctual and consientious in the fulfillment of my duties, and if for any reason I cannot serve at the assigned time, I will notify my assigned supervisor.

2. I will conduct myself with dignity, courtesy and consideration.

3. I will consider as confidential all information which I may hear directly or indirectly concerning a patient, doctor or any member of the staff and will not seek information in regard to a patient, doctor or any member of the staff, including my own medical information.

4. I will discuss any problems, criticism or suggestions with the volunteer services department.

5. I will endeavor to make my work of the highest quality.

6. I will uphold the standards and policies of the hospital.

7. I will attend any hospital/volunteer department continuing education programs which will help me improve my service to the hospital, and which are required.

8. I understand that failure to comply with the above could result in termination.



I Agree

I certify that all of my answers and statements are complete and true. I hereby authorize my references to furnish complete and honest information to the hospital. I realize that falsification or omission of any information, receipt of a poor reference, or a conviction record may be cause for withdrawal of any volunteer offer. I understand that this application is not a contract for service. I also understand and agree that, if accepted, my service would be for a mutually agreed period of time.