Volunteer Services Application Form

Identification Information (Please list your legal name)

First Name

Middle Name

Last Name

If you have an alias, nickname or change of name due to marriage or divorce please let us know.

Street Address

City

Zip Code

Home Phone

Work Phone

Cell Phone

E-mail address

Emergency Contact

Name

Relationship

Phone

Experience, Skills and Interests (tell us about yourself)

How did you find out about our volunteer program at Paradise Valley Hospital?

Why do you want to volunteer?

Please list other volunteer experience or organizations, clubs, professional societies, or other associations to which you belong or have belonged to.

Is the purpose of volunteering is to get hours for school or higher education program?

Do you read, speak or write a language other than English?

Please list: If yes, do you mind interpreting non-medical information for patients/visitors?

There are criteria and physical requirements for each position. We will try our best to assign you to and available position that will accommodate your skills, and will be mutually beneficial to you and the Auxiliary/hospital. We will discuss possible placement options with you before we assign you to a position.

Do you need accommodations for a medical/physical limitation?

If yes please list:

Conviction Record (This must be completed to be considered for volunteering)

Have you ever been convicted of a felony or a misdemeanor that has not been judicially expunged, sealed or eradicated?

Do you have any felony or misdemeanor charges pending against you that are unresolved?

At Paradise Valley Hospital we require all Volunteer prospects to take a Background check. Before this application is given.

Agreement:

I understand I will be asked for government issued ID to verify my identity, and authorize agencies and persons contacted for reference or background information to release information.
I understand any misrepresentation or material omission of information in this application may be a cause of dismissal from the Volunteer Program.
I understand that the Auxiliary cannot guarantee a position, and that there are qualifications, requirements, competence and physical criteria for positions. The Volunteer Program will try its best to find me a position that meets my skills/needs and that of the hospital.
I understand that state and national hospital regulatory agencies require that persons working/volunteering in a hospital setting receive Annual Essentials, Code of Conduct, HIPAA Privacy Legislation that are included in this application and have an annual TB test. We require for all applications to obtain a Health clearance from our Employee Health Nurse. Office hours for our Employee Health Nurse are Monday-Friday 7:00am - 3:30pm; 619-470-4169.
I agree to read, abide by the policies and procedures, expectations, ethics customer service standards as presented in the mandatory training and orientation and to perform the duties expected of me to the best of my ability
I understand that I donate my services to the hospital without contemplation of compensation or future employment.
I understand that my volunteering opportunity may be terminated at any time for any reason as a result of: failure to comply with policies and regulations; absences without notification; unsatisfactory attitude, performance or appearance; or any other circumstance, in the judgement of the coordinator that would make my services as a volunteer contrary to the best interest of the Auxiliary and/or hospital.
I agree to make an effort to fulfill my commitment, be punctual and conscientious and conduct myself with dignity, courtesy, and consideration of others.

I hereby certify that all the information included on this application is true and complete to the best of my knowledge.

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Volunteer Services Application Form

Identification Information (Please list your legal name)

Emergency Contact

Experience, Skills and Interests (tell us about yourself)

Conviction Record (This must be completed to be considered for volunteering)

Agreement:

Paradise Valley Hospital

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