Personal Interests - Tell Us About Yourself
Education and Work Experience
Last Grade Completed
Please describe the days and times you are most often available to volunteer. Shifts are available 7 days a week from 8 a.m. - 12 p.m., 12 p.m. - 4 p.m. and 4 p.m. - 8 p.m.
Person to Be Contacted in an Emergency
List Two Local References
If accepted as a hospital volunteer, I agree that:
1. I shall hold as absolutely confidential, all information that I obtain directly or indirectly concerning patients, doctors or staff, and not seek to obtain confidential information. 2. My services are donated to the hospital without contemplation of compensation or future employment, and given with humanitarian, religious or charitable reasons. 3. I shall submit to an annual tuberculin skin test and any other health examination which may be necessary as part of my volunteer services. 4. I agree, as an adult 18 years or older, to submit to the required background screening. 5. I understand I will be required to complete safety education annually. 6. I shall be punctual and conscientious, conduct myself with dignity, courtesy and with consideration of others, and endeavor to make my role as a volunteer professional in quality. 7. I shall make my best effort to fulfill my commitment to the hospital by completing all assignments that I accept. 8. I shall at all times uphold the philosophy and standards of the hospital. 9. I 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) absences without prior notification; (c) inappropriate behavior, work appearance; or (d) any other circumstances which, in the judgment of the department director, would make my continued services as a volunteer, contrary to the best interests of the hospital. I have read each of the above conditions and I agree to be bound by them as well as all hospital policies and procedures with The Valley Health System.