Thank you for your interest in volunteering with Salem Health in Salem, Oregon. This application is to be filled out after watching our online Information Session. Please complete this application form if you are over 18 years old. Once you complete the form, click the "Continue" button at the bottom of the page to submit your application. Questions marked with an asterisk (*) are required. If not applicable, please enter "n/a."


Name, Contact, and Demographic Information

Please provide your name and contact information.



Emergency Contact Information

Provide the name and contact information of the person you would want the hospital to contact in case of an emergency situation.



Availability, Skills, and Interests

Use the check-boxes below to select your daily availability, share your skills, and select service areas of interest. All areas are subject to availability. We are unable to guarantee placement choice.

(Please note: for Pet Therapy, you must have your own certified pet therapy animal).



References

List two references to evaluate you as a volunteer candidate. Relatives and family members may not serve as references.



How did you hear about us?


Info Session Quiz 1

The following question has to do with the Information Session Video you watched prior to starting the application.



Info Session Quiz 2

The following question has to do with the Information Session Video you watched prior to starting the application.



Info Session Quiz 3

The following question has to do with the Information Session Video you watched prior to starting the application.



Personal Appearance Standard

The personal appearance of volunteers at Salem Health is important to the impression that patients, families, visitors, and staff have about Salem Health. Our volunteers dress with taste and discretion to convey a clean, well-groomed, professional appearance.


•Clothing and attire must be clean, neat, and in good condition. Tops should not be overly tight, revealing, or contain any large logos. Bottoms (slacks, jeans, leggings, etc.) must be past the level of your knee, free of rips/holes or obvious stains, and opaque. Scrubs, sweatpants/shirts, shorts, flip flops, and pajamas are not permitted.

•Uniforms will be maintained neatly and cleanly. Volunteers will wear the uniform appropriate for their role at all times: a black vest for adult volunteers, a yellow vest for Pet Therapy volunteers, and a red polo shirt for students.

•Your ID badge must be worn at all times, above the waist and clearly visible.

•A hospital-issued face mask must be worn securely over the mouth and nose at all times while on campus.

•Volunteers must maintain clean personal hygiene. Considerations should be used in the application of personal care products to be unscented or fragrance-free whenever possible. Perfumes, colognes, after shaves, and other heavily scented/fragranced personal care products are not permitted.

•Grooming is essential for the overall professional appearance of all workforce members. In a healthcare environment, including all clinical and non-clinical areas, it is important for workforce members to be clean and well groomed.

•Hair must be clean, neatly trimmed, and contained in such a manner that it does not come in contact with patients. Hairstyles, hair color, and cosmetics should project a professional image.

•Jewelry should be small and simple.

•Any visible tattoo that includes the following is unacceptable: gang-related images or language; prison/crime/drug-related tattoos; offensive/profane language; images depicting any type of nudity or sexual images; images showing any type of intolerance, racism, hate, or bigotry; tattoos with “dark” images related to death or pain (e.g., skulls or demons); or anything that, in the judgment of management, is considered to be offensive to others.


By typing my name in the box below, I agree to follow the above dress code and understand that arriving for orientation, training, or my volunteer shift wearing clothes that do not meet the dress code may result in my being sent home. If I have any questions or clarifications about the dress code, I will discuss them with the Volunteer Services staff so I can fulfill the dress codes standards commitment. I also understand that there may be consequences if I repeatedly break the dress code standards, up to and including removal from my volunteer position.



Volunteer Consent to Photograph or Interview

As requested by Salem Health or a member of the media, I consent to and authorize photographs or videotape recordings to be taken.


I also consent to be interviewed by a representative of the media or Salem Health for purposes of publication.


I further authorize and consent to the use of still or video images by the media and/or Salem Health in print publications, hospital or media Web sites, or broadcast productions.


By typing my name in the box below, I have read, understand, and agree with the Volunteer Consent to Photograph or Interview expectations.



Adult Volunteer Agreement

I certify that the information contained in this application is true, correct, and complete to the best of my knowledge. I understand that continuation of any subsequent volunteer placement depends upon true and accurate representation of the facts stated or implied herein. In addition, I hereby authorize Salem Health to make inquiries regarding my education, work experience, and references, unless otherwise stated. I hereby release all parties and persons associated with any such inquiries from all claims, liabilities, and damages for whatever reason in connection with information they give.


I acknowledge and agree that I am not obligated if called upon to perform the volunteer services herein applied for, and that Salem Health is not obligated to assign or actively seek to assign me to a placement.


I understand this application is not a contract of employment. If I am accepted as a volunteer, I agree to abide by and conform to all policies and procedures of Salem Health and Volunteer Services.


I understand that my services are donated without contemplation of compensation or future employment. I am donating my services and they are given with humanitarian reasons only.