CHI St. Joseph Health Volunteer Application - Therapy

Please complete this application form if you are interested in becoming a volunteer at CHI St. Joseph Health in Bryan, Texas, in our physical, occupational or speech therapy areas. Once you complete the form, click the submit button at the bottom of the page.

Requirements to Volunteer

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

1. Be in good health

2. Provide a letter of reference. The letter can be from an employer, church, civic/volunteer organization, school or teacher/professor. It should include specific information about your character and qualities you possess.

3. Pass background screening

4. Complete online orientation and forms

5. Complete TB testing (required prior to beginning to volunteer and updated yearly).

6. Complete Influenza vaccination (required if you volunteer between October 1st and March 31st yearly)

I acknowledge volunteer requirements:

Contact Information

Please complete this section.

First name:

Last name:

Middle name:

Title:

First name for your badge:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Spouse's name:

Demographics

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

Date of birth:

Age:

Gender:

Shirt size for uniform:

Degree(s) Earned:

Social security number:

If you are currently in college, please indicate which school you attend, your degree plan, and year you will graduate:

Skills, Experience & Interests

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 and your level of commitment.

College students - applying for:

What length of time are you able to com:

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

I would like to serve _ hours per week:

Additional scheduling considerations:

Assignment Preference

The following volunteer assignments may currently be available. You may click the assignment names to learn more that assignment. Use this list to rank your top three assignment choices.

* Assignment Preference:

1st choice:

2nd choice:

3rd choice:

Additional assignment considerations:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Relationship:

Personal References

Please submit a personal reference. Must be over 21 years old and not members of your family.

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Relationship:

Email

We like to keep volunteers informed of important news, policy and procedure updates, schedules, and volunteer opportunities by email.

Email address:

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 feature. Please select a password you would like to use to access the online Volunteer Information Center. Your password must be a minimum of 4 characters and/or numbers.

Please enter a password that:

Is between 4 and 30 characters long

Password:

Confirm password:

Background Checks:

We consider the safety and security of patients to be of the utmost importance. Applicants must complete a background history to be screened for criminal background 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 St. Joseph. 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.

Explanation:

I Agree

I understand and agree that submitting this application form does not automatically register me as a CHI St. Joseph Health 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.

I Agree

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