Application Deadline is Thursday April 13, Complete (include

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1 Dear Junior Volunteer Applicant, Thank you for your interest in participating in the 2017 Junior Volunteer Program at Pardee Hospital. Your service is greatly appreciated by our staff, patients, and their families. The program s primary goals are to teach the value of community service and to expose our Junior Volunteers to the healthcare field. Qualities that we are looking for in our Junior Volunteers include dependability, promptness, honesty and professionalism. Pardee Hospital has Performance Standards that Junior Volunteers will be expected to abide by: Attitude, Compassion, Teamwork, Intercommunication, Ownership, Neat Appearance, and Sincere Customer Attention. These will be reviewed during orientation. Junior Volunteer responsibilities include, but are not limited to, escorting patients and visitors to their destinations, transporting patients and visitors in wheelchairs, working in the Garden Café, Orchard s Café, and assisting in various other departments. All of our Junior Volunteer positions are important. Summer Junior Volunteer Program Important Dates/Length of Program The 2017 Orientation dates are: Friday, June 16 th OR Tuesday, June 20 th. Junior Volunteers must complete one full day of orientation. Please understand that we have a limited number of volunteer opportunities and we cannot guarantee every applicant a volunteer position. The last day of the Junior Volunteer program is Friday, August 11, Junior Volunteers are expected to work at least four hours per week (Monday through Friday) between 8:00am and 4:00pm. Junior Volunteers will not volunteer on weekends. As we review Junior Volunteer applications, we may contact you to come in for a brief interview. In order to be considered for a Junior Volunteer position at Pardee Hospital, you must meet all of the following requirements: Be at least 14 years old by April 1, Application Deadline is Thursday April 13, Complete (include required signatures of both the student and parent/guardian) and return all application documents, 1 through 4 to Karla Reese, Volunteer and Chaplain Services Director.

2 Submit All Application Documents: 1. Pardee Hospital Junior Volunteer Program Application 2. Junior Volunteer Health Form 3. Junior Volunteer Reference Form 4. Junior Volunteer Questionnaire and Pledge form Attend the REQUIRED orientation meeting on Friday, June 16, 2017, from 8:30am to 4:00pm OR Tuesday June 20, 2017, from 8:30am to 4:00pm. You must complete this orientation in its entirety; no exceptions. You may hand deliver your completed application packet to me personally or Barbara Alexander in the Chaplain s office ( ), or you may mail it to: Pardee Hospital Volunteer Services-Box 2 Attention: Karla Reese 800 N. Justice Street Hendersonville, NC If you are selected as a Junior Volunteer, you will need to have a Tuberculin Skin Test. This will be provided at Pardee Hospital at no charge. This is not required at the time of your application. This program will give you the opportunity to learn about the many career possibilities in healthcare as you learn the essentials of commitment and responsibility while serving others in a meaningful way. Thank you for applying to the Pardee Junior Volunteer program. Please feel free to contact me if you have any questions. Sincerely, Karla Reese MHS, BSW Volunteer and Chaplain Services Director karla.reese@unchealth.unc.edu

3 Pardee Hospital Junior Volunteer Program Application 1. Name: Date: Last First Middle Initial Address: City: State: Zip: Home Phone: Cell: Date of Birth: 2. Parent/Guardian Info: Name: Employer: Work/Cell: Name: 3. Emergency Contact (Other than Parent or Guardian): Employer: Work/Cell: Name: Phone: Relationship: Name: Phone: Relationship: 4. School Name: Grade in Fall: Size of Polo Shirt: Do you have a preferred day to volunteer? Yes No If yes, what day? Second choice: Are you going to be unavailable on certain dates (i.e., vacation)? If so, please list: Do you have relatives employed at Pardee Hospital? Yes No Name: Relation: Department: *Have you been a Junior Volunteer here in the past? Yes No How many years? *If so, where did you volunteer (department)? 5. Summer Program: Monday through Friday, 8:00 a.m. to 4:00 p.m. No weekends. Parents/guardians must arrange for prompt pick-up of Junior Volunteers after they complete their scheduled volunteer assignments. 6. Students accepting this position must follow and comply with the rules and regulations expected of adult volunteers, and Team Members. Signature of Applicant: Date: Parent/Guardian Consent: I consent to the above named student applying to the Pardee Hospital Junior Volunteer Program and understand that he/she will be expected to comply with the rules and regulations of Pardee Hospital. Signature: Date: (02/22/2016)

4 Junior Volunteer Health Form Name: Phone: Physician: Phone: Please answer the following questions regarding your child s current health status. Is your child currently under the care of a doctor? Yes No If so, please explain: Is your child presently taking any medications? Yes No If so, please list: Does your child have any allergies? If so, please list: Yes No Does your child have Diabetes? Yes No Does your child have Asthma? Yes No Please list Asthma medications. Does your child have any other medical conditions that we need to be aware of? I acknowledge that my child is at least 14 years of age and is in good health. I hereby give my permission to have my child volunteer at Pardee Hospital. Signature: Date: Parent or Guardian (03/11/2013)

5 Junior Volunteer Reference Form Applicant Name *Reference Name *(Reference person must be a teacher, counselor, coach or employer) The applicant is applying to the Junior Volunteer Program at Pardee Hospital. This program offers an opportunity for students to learn the value of community service and become acquainted with the hospital environment. Please hand completed application back to the applicant in a sealed and signed envelope. Thank you! How long have you known the applicant and in what capacity? Can you depend on this student to complete assigned tasks? Please provide examples or qualities that support this. Do you feel this student will fulfill a once a week volunteer duty? Please provide an example of time management Does this student act maturely and respectfully around both adult and peer groups? Please provide an example of this behavior Please provide any other helpful information as it relates to being a volunteer and working in the hospital so that we can make an appropriate assignment. Do you recommend this applicant as a Junior Volunteer? Signature Date (02/20/2014)

6 Junior Volunteer Questionnaire Name: Please type your complete answers on a separate sheet of paper. Your answers should be one paragraph in length. Total word count should be no more than Why do you want to be a Junior Volunteer at Pardee Hospital? 2. What are your career plans? 3. Why do you feel you would make a good Junior Volunteer at Pardee Hospital? PLEDGE 1. I will respect staff, fellow volunteers, visitors and patients and will abide by the Pardee Performance standards. 2. I will not bring my personal cell phone to work and I will provide my parents or guardian with contact information for the hospital if they need to contact me while I am at work in my volunteer role. 3. I will abide by the Pardee dress code and wear my name badge, neat, laundered Junior Volunteer polo shirt, tan or khaki pants, white or brown shoes (no open-toed shoes or flip-flops). Personal hygiene will be appropriate to include Pardee s no scent policy. The replacement fee for a lost name badge is $ I understand that all Junior Volunteer positions are important to the organization. I also understand that opportunities in clinical areas are limited. 5. I will be prompt on my scheduled volunteer day. I will remain in my designated department for the duration of my work. I understand that I cannot go to other departments and help out or hang out while other Junior Volunteers, relatives or family friends are working. I cannot go to another department to volunteer that does not have Junior Volunteers. I understand that I must provide 24 hours notice if I am unable to work on my assigned day. I will call my supervisor contact person in my assigned department. Student Signature Date Parent/Guardian Signature Date (02/27/2014)