Volunteer Application Form

Please complete this application form if you are over the age of 18 and are interested in becoming a Kootenai Health volunteer.

We improve health one patient at a time in a friendly and professional culture committed to superior quality and safety. Our volunteers play a large role in delivering quality services by serving in a variety of ways throughout the hospital. Our volunteers must possess self-motivation and reliability.

We greatly appreciate your interest in volunteering at Kootenai Health. Before submitting this application, please read the information below.

We are very fortunate to have many individuals interested in volunteering and sometimes more than we have service openings for. The volunteer role is extremely important as everyone representing Kootenai Health has an impact on our patients and their experience with us. A few items to keep in mind:

• Volunteering is not job shadowing.

• We do not offer internships through our volunteer program.

• We cannot create a position based on personal or professional goals. We have specific volunteer roles that enhance the services we provide.

• Before applying, please ask yourself, “Am I applying because I have a sincere drive to help?” and “Can I consistently commit to one shift every week?

Once you complete the form, click the "CONTINUE" button at the bottom.

Contact Information

First name:

Last name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Emergency Contact

First name:

Last name:

Home phone:

Cell phone:

Other phone:

Relationship:

Availability

Please indicate the dates and times you are usually available to volunteer. (Skip if you are interested in the Patient Family Advisory Council)

Length of Placement

How long do you intend to volunteer:

1 year or longer

6 - 12 months

Less than 6 months

Type of Service

Please select the areas that you're interested in helping. Please note that Patient Family Advisory Council requires you to attend a monthly meeting. Spiritual Support is a night shift. Pet Therapy is only available to those who are dog CGC certified. With Mended Hearts you must be a previous heart patient. Nightingales is for retired nurse volunteers.

References (Personal or Professional)

1

2

First name:

Last name:

Work phone:

Cell phone:

Relationship:

Volunteer History

Please list previous volunteer experience.

Expectations

Why do you want to volunteer at Kootenai Health?

Current or Former Employee

Check the appropriate box below if you've ever been employed by Kootenai Health?

Current employee:

Former employee:

Skills and Experience

Do you have current or previous work experience?

Criminal History

Kootenai Health completes a background check on all volunteers prior to serving at any of our facilities. Check the box below if, at any age, you've been convicted of a crime (including withheld judgements, or other plea arrangements, and any pending charges)? Crimes include: felonies, misdemeanors, traffic violations, etc. Answering "yes" does not automatically exclude you from volunteering.

Criminal History:

Yes

If yes, or not sure, please provide details:

Terms and Conditions

Flu Vaccination Policy: In the spirit of safeguarding patients – as well as you, our employees, faculty, physicians, staff, students and volunteers – a mandatory flu vaccination policy has been implemented across Kootenai Health.

If accepted as a volunteer:

1. I understand that Kootenai Health volunteers are required to receive an annual flu vaccination. Individuals with severe reactions to any component of the flu vaccine, other than egg proteins, must provide written documentation from their primary care physician stating such.

2. Certify all statements made on this application to be true, correct, and complete to the best of my knowledge and made in good faith.

3. I understand that volunteering is contingent upon successfully passing a drug screening test per Kootenai Health Policy.

4. Shall submit to health screen examinations, which may include chest X-rays and a blood drawn TB test as part of my volunteer services application. I also authorize the person(s) making tests or x-ray films to report the results to the volunteer office.

5. Agree to the use of confidential information only as needed to perform my volunteer duties. This means I will not access confidential information without legitimate need/permission, nor in any way divulge, copy, release, sell, lend, revise, alter, or destroy any confidential information that belongs to Kootenai Health. I understand that I will be automatically dismissed as a volunteer if I do not respect my responsibility for maintaining confidentiality.

6. Agree to donate my services to Kootenai Health and to give for humanitarian, religious, or charitable reasons.

7. Shall not sell or attempt to sell goods or services, request contributions or solicit persons to sign or distribute political petitions on hospital premises, unless I receive the express authorization of the of Volunteer Services Manager to engage in these activities.

8. Shall be punctual and conscientious, conduct myself with dignity, courtesy and consideration of others, and endeavor to make my work professional in quality.

9. Shall attempt to resolve any problems related to my volunteer activities with my supervisor, and, if unsuccessful, attempt to resolve any such problems with the Volunteer Services Manager.

10. Shall make my best effort to fulfill my commitment to Kootenai Health by completing all assignments that I accept.

11. Shall uphold the mission of the organization at all times.

12. Authorize a reference & criminal background check, as well as investigation of any and all statements contained in this application, for the purpose of determining volunteer decisions.

13. Understand that the volunteer services department reserves the right to terminate my volunteer status as a result of (a) failure to comply with hospital policies, rules, and regulations; (b) 3 absences without prior notification; (c) unsatisfactory attitude, work, or appearance; or (d) any other circumstances which, in the judgment of the department Manager, would make my continued service as a volunteer contrary to the best interests of the patients and Kootenai Health.

14. I understand and agree to a 90-day probationary period commencing upon my first shift to ensure all duty requirements.

I Agree