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Good Shepherd encourages the participation of volunteers who support our mission, vision and values. If you agree with our mission and are willing to be interviewed and trained in our procedures, we encourage you to complete this application. The information on this form will be kept confidential and will help us find the most satisfying and appropriate volunteer opportunity for you.

Thank you for your interest in Good Shepherd Health Care System.

    PERSONAL INFORMATION

    First Name: *

    Last Name: *

    Middle Initial:

    Name to Appear on Badge: *

    Address: *

    City: *

    State: *

    Zip: *

    Phone Number: *

    Email Address: *

    Birthday: *

    Age: *

    Are you a year-round resident? *

    If no, what months are you available? *

    EDUCATION

    Check all that apply: *

    Degree(s):

    WORK STATUS

    Select One: *

    If employed, what is your current place of employment: *

    Employer Phone: *

    SKILLS / WORK EXPERIENCE

    Interests: *

    If Other, please share your other skills and work experience: *

    Have you ever committed, been convicted of, pled guilty to, or pled no lo contender to, a felony or a misdemeanor? NOTE: Conviction of a crime is not necessarily grounds for disqualification. *

    If Yes, please explain: *

    VOLUNTEER AVAILABILITY

    Please indicate the days and times you are available to volunteer: *

    What is appealing to you about volunteering in a healthcare setting? *

    Any special talents or skills you have that you feel would benefit our organization? *

    IN AN EMERGENCY, PLEASE NOTIFY

    Name: *

    Relationship: *

    Address:

    Home Phone:

    Cell Phone: *

    Physician Name: *

    Physician Phone: *

    HOW DID YOU HEAR ABOUT OUR PROGRAM?

    Check all that apply: *

    If Other, please specify: *

    SERVICE AREA OPPORTUNITIES

    Please check any that would interest you: *

    I confirm that the information provided in this application is true in all respects, without any willful omissions. I understand that if this application is false in any way, I will be dismissed without notice regardless of when the false information is discovered.

    I understand that completing this application does not guarantee me a volunteer position and that I still must undergo an in-person interview and background check before being considered for a volunteer position.

    If I am selected as a volunteer, I

    • agree to a six-month commitment with a minimum of one shift per month
    • agree to complete the volunteer orientation and train until I am competent to perform the required duties
    • agree to complete an annual education review and employee health screening, as well as any additional service-specific training that may be deemed necessary
    • agree to comply with all the rules and regulations of Good Shepherd Health Care System and to uphold the bylaws of my volunteer organization
    • understand that I may be dismissed from my duties for willful wrongdoing or negligence and/or performing duties outside of my service guidelines
    • agree to contact my volunteer supervisor as soon as possible to request volunteer or schedule changes

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