Junior Volunteer Program

Size: px
Start display at page:

Download "Junior Volunteer Program"

Transcription

1 5126 Hospital Drive Covington, GA Tel: Junior Volunteer Program Information Packet Piedmont Newton Hospital Volunteer Services Summer 2016 June 13 July 22 1 P age

2 January 22, 2016 Dear Prospective Junior Volunteer and Parent or Guardian, Thank you for your interest in participating in the Piedmont Newton Hospital Volunteer Services 2016 Junior Volunteer Program. This program runs for 6 weeks from June 13 - July 22, It is for students from Newton County and children and grandchildren of Piedmont Newton employees and volunteers. This is not an internship program but rather a service to Piedmont Newton Hospital. This program provides an opportunity for students to gain exposure to a hospital environment, while making a contribution to the community. To participate in this program you must volunteer a minimum of 20 hours by working one, four hour shift per week. Therefore, please consider carefully whether this time commitment will fit in with any family vacations, sport commitments, part-time work schedules, or any other obligations you may have. Your willingness and ability to make a commitment to your volunteer assignment is crucial because the department in which you will be volunteering depends on you. As such, you will only be permitted one week off in order to satisfactorily complete the program. Included herein is the Application Packet. Below is important information regarding the application process: 1. The Junior Volunteer Application Packet will be available on February 1, The following forms must be returned by all applicants by Friday, April 1, 2016: a. Junior Volunteer Application b. Two Letters of Reference using the enclosed forms and returned as specified on the forms. c. Returning Jr. Volunteers are not required to interview, but are required to call the Volunteer Office to confirm receipt of all application paperwork. d. Signed Junior Volunteer Agreement e. Signed Parental/Legal Guardian Agreement 1. Interviews will be held between 3:00 pm and 5:30 pm on Tues., April 19 th, Wed., April 20 th and Thurs., April 21 st. 2. Uniform polo shirts will be distributed at orientation on Friday, June 10th. A $20 uniform shirt fee will be collected at that time. 3. Upon acceptance to the program, you will receive information via regarding the required urine drug screening, tuberculosis screening, and mandatory orientation scheduled for Friday, June 10 from 8:00 a.m. to 12 Noon. 4. Due to the limited number of available positions, final placement will be determined by lottery. The interview process does not guarantee placement. 5. You will be notified by only as to whether or not you have been accepted to the program. Your assignment will be given to you at orientation. If you have any questions or concerns, please contact the Volunteer Services Office at (770) , or by at Our mailing address is: 5126 Hospital Drive, Covington, GA The Volunteer Services office is staffed Monday-Friday from 8:00 a.m. 4:30 p.m. Sincerely, Andrea Lane Manager, Volunteer Services 2 P age

3 TABLE OF CONTENTS Application. 4 New Applicant - Reference 1..6 New Applicant - Reference 2..7 Junior Volunteer Agreement 8 Parental/Legal Guardian Agreement: 9 Tuberculosis Surveillance Program for Non-Employees.10 JuniorVolunteer Dress Code.11 Zero Tolerance Policy 12 3 P age

4 FOR OFFICE USE ONLY Date rec d. / / 2016 JUNIOR VOLUNTEER Application Check One: New Junior Volunteer Returning Junior Volunteer (does not include CEC program) (print) Last Name: First Name: Middle Initial: Street Address: City: State: Zip: Home Phone: Cell Phone: Sex: M F Birthdate: / / School Attending: Class of: Age: Do you have any family member who is an employee or a volunteer at Piedmont Newton Hospital? Yes No - If yes, please list name(s), relationship(s) and work area: How did you hear about the Jr. Volunteer Program at Piedmont Newton Hospital? Do you have any physical limitations requiring special accommodations in order for you to volunteer? Yes No - If yes, please explain: Interest/Skills List any prior work experience or volunteer service: List foreign languages that you write or speak: List any other special skills such as, keyboarding, computer skills, sign language, etc.: 4 P age

5 Scheduling Check shift and days you are available for volunteer assignments (Note: exact hours vary by department needs). Weekday Mon Tue Wed Thu Fri Morning Afternoon We realize you may not know all of your summer plans, but please list the dates you will be unable to work this summer due to family vacations, driver s education, school, band camp, sports, etc. (To participate in this program, you must volunteer a minimum of 20 hours by working one, 4-hour shift per week.) Dates Unavailable: Name of Parent/Legal Guardian (print) Parental Information and Agreement Street Address: City: State: Zip: Home Ph: Work Ph: Cell: All Jr. Volunteers must be covered by a family hospitalization policy, which must be listed below. Should it become necessary to seek medical attention in the emergency room, your insurance will be utilized. In case of emergency, notify: Name: Relationship: Phone No: In the event I cannot be reached, permission is hereby granted to treat my child, -, for any problem that might occur while on duty as a volunteer. Parent/Legal Guardian Signature: Date: / / Insurance Information: Policy Holder s Name: Policy No: Company: I hereby certify that the answers on this application are true and correct and that any omission of facts or misrepresentation, misleading or false information on my part will be grounds for dismissal as a volunteer. I will abide by all rules and regulations established. I understand that at anytime I fail to abide by the established rules and regulations, I will forfeit my privilege to serve as a volunteer and may be discharged without warning or notice. Acceptance as a volunteer is contingent upon satisfactory references and verification of the information submitted. I authorize that all employers, schools or references thus contacted shall be released from all liability in answering inquiries related to my application. / / / / Jr. Volunteer Signature Date Parent/Legal Guardian Signature Date 5 P age

6 2016 JUNIOR VOLUNTEER New Applicant Reference #1 School Counselor Volunteer s Last Name: First Name: Date: / / School Attending: Reference s Name (Printed) Dear School Counselor, First & Last Name: Contact Number (optional): The individual named above has applied for the JUNIOR VOLUNTEER PROGRAM at Piedmont Newton Hospital. Your assistance is requested in evaluating the applicant with regard to the following qualities. Candid completion of this information will give us an opportunity to properly review his/her qualifications and assign them to an appropriate area if all qualifications are satisfactorily met. Personal Appearance: Maturity: Ability to get along with others: Attitude toward taking directions: Sense of Responsibility: Dependability: Additional Comments: Signature: Date: To assure confidentiality and proper processing of this information, please complete this form and return to student in a sealed envelope or you can scan and it directly to the Andrea Lane at If you have any questions, please call the Volunteer Office at (770) RETURN TO VOLUNTEER SERVICES OFFICE 6 P age

7 2016 JUNIOR VOLUNTEER PROGRAM New Applicant Reference #2 Personal Volunteer s Last Name: First Name: Date: / / School Attending: Reference s Name (Printed) First & Last Name: Dear (Please circle one) Principal / Teacher / Coach / Minister or Adult Friend: Contact Number (optional): The individual named above has applied for the JUNIOR VOLUNTEER PROGRAM at Piedmont Newton Hospital. Your assistance is requested in evaluating the applicant with regard to the following qualities. Candid completion of this information will give us an opportunity to properly review his/her qualifications and assign them to an appropriate area if all qualifications are satisfactorily met. Personal Appearance: Maturity: Ability to get along with others: Attitude toward taking directions: Sense of Responsibility: Dependability: Additional Comments: Signature: Date: To assure confidentiality and proper processing of this information, please complete this form and return to student in a sealed envelope or you can scan and it directly to the Andrea Lane at If you have any questions, please call the Volunteer Office at (770) RETURN TO VOLUNTEER SERVICES OFFICE 7 P age

8 2016 JUNIOR VOLUNTEER PROGRAM Junior Volunteer Agreement As a Jr. Volunteer at Piedmont Newton Hospital, I promise to: 3. Obtain, complete and submit all required information necessary for processing by Friday, April 1, 2016 to Piedmont Newton Hospital Volunteer Services, 5126 Hospital Drive, Newton, GA Interviews will be held between 3:00 pm and 5:30 pm on Tues., April 19 th, Wed., April 20 th and Thurs., April 21 st. YOU must call to schedule your interview appointment. We will do our best to accommodate your appointment time request. 5. Returning Jr. Volunteers are not required to interview, but are required to call the Volunteer Office to confirm receipt of all application paperwork. 6. Obtain Urine Drug Screening and TB (Tuberculosis) Test at Occupational Health Services, free of charge through Piedmont Newton Hospital, and update my tetanus shot, if necessary. 7. Attend a one-day mandatory Orientation and Training Meeting for all new and returning Jr. Volunteers to be held on Friday, June 10, 2016 from 8:00 a.m. to 12:00 p.m. at the hospital. 8. Serve a minimum of 20 hours from June 13 July 22, (All new and returning Jr. Volunteers are required to serve one, 4-hour shift per week. 9. Ensure that written, advance notification of time to be missed for family vacations, driver s education, school, band camp, sports, etc. is included in the application. 10. You will be required to find a substitute if you are unable to volunteer on your scheduled date. We will provide a schedule and sub list at orientation. 11. Be dependable and fulfill my work assignments. Always conduct myself with dignity and courtesy. Provide my highest quality work. 12. Be punctual and sign in and out at designated location. 13. Read and comply with the Zero Tolerance Policy. 14. Consider all information I hear, either directly or indirectly, concerning a patient or a member of the hospital staff to be confidential. 15. Act and dress professionally, following the Piedmont Healthcare s Code of Conduct, Policies & Procedures and Dress Code. 16. Be committed to enjoying this learning experience by serving patients, visitors, staff and fellow volunteers in a friendly, courteous manner. 17. Return my Identification Badge at the end of the 6-week program. 18. Check my regularly for messages from the Volunteer Services Office as all information will be sent electronically. Junior Volunteer Signature Date: / / RETURN TO VOLUNTEER SERVICES OFFICE 8 P age

9 2016 JUNIOR VOLUNTEER PROGRAM Parental/Legal Guardian Agreement 1. I hereby permit my child, to join the Junior Volunteer Program at Piedmont Newton Hospital. I understand the importance of responsibility and will assist my child in complying with the program s rules and regulations. I will assume responsibility for his/her transportation. 2. I have read and understand the Zero Tolerance Policy. 3. I agree that my student s Identification Badge will be turned in at the end of the 6-week program. 4. In the event of a medical emergency, I permit the physicians in the Emergency Department of Piedmont Newton Hospital to treat my student. 5. I understand that in order for my student to participate in the program, all necessary information must be obtained, completed and submitted by Friday, April 1, Interviews will be held between 3:00 pm and 5:30 pm on Tues., April 19 th, Wed., April 20 th and Thurs., April 21 st. I agree to attend the interview with my student as a mandatory part of the application process. Please note: THE STUDENT needs to call to schedule their interview appointment. We will do our best to accommodate their appointment time request. 7. Returning Jr. Volunteers are not required to interview, but are required to call the Volunteer Office to confirm receipt of all application paperwork. 8. I understand my student will be required to pay $20.00 for the uniform shirt. (All volunteers will need a new shirt as our colors and logo has changed to Piedmont.) 9. I hereby give permission and will accompany my student to receive a Urine Drug Screening and TB (Tuberculosis) Test at the Occupational Health Services office located on the 2 nd floor of the main hospital building. Tel: (770) Screenings and tests are provided by Piedmont Newton Hospital at no charge. 10. I understand that my child is required to serve a minimum of 20 hours from June 13 July 22, Written, advance notification of time to be missed for family vacations, driver s education, school, band camp, sports, etc. must be included in Application Form. Last minute schedule changes are very disruptive to the hospital staff and volunteer office. The Volunteer Office staff is not responsible for adjusting your child s schedule so that they can obtain the necessary hours. 11. I understand that all information will be communicated electronically to my child s and that I will need to check their regularly for messages. Parent/Legal Guardian Signature: Date: / / RETURN TO VOLUNTEER SERVICES OFFICE 9 P age

10 2016 JUNIOR VOLUNTEER PROGRAM Junior Volunteer Dress Code 1. Red polo shirt with the hospital logo (to be purchased at the Volunteer Services office). Shirt must be tucked into pants. 2. Khaki pants with belt: NO cropped, capris, shorts, cargo or baggy pants. 3. Nails must be natural and if painted, not chipped and polish must be a conservative color. 4. Picture and name visible. Secured on right shirt lapel. 5. Clean, appropriate color, comfortable shoes (no open-toe shoes or flip-flops). 6. Conservative jewelry. 7. No perfume. 8. Uniform must be neat and clean. 9. Cell phone must be kept in pocket (on vibrate) and not visible or on belt holster. 10. Act and dress professionally, following the Piedmont Healthcare s Code of Conduct, Policies & Procedures and Dress Code. PLEASE RETAIN FOR YOUR RECORDS 10 P age

11 2016 JUNIOR VOLUNTEER PROGRAM Zero Tolerance Policy The following discipline issues will result in immediate termination from the Piedmont Newton Hospital Youth Volunteer Program: Theft of hospital, patient, employee, volunteer, or guest property. Willful damage of hospital property. Fighting or attempting bodily injury to any person on hospital property. Public display of affection (PDA) of any type. Immoral or lewd conduct. Use of cell phone to text, check social media, or make non-emergency phone calls while on duty. Refusal to perform assigned task-insubordination. Walking off the assigned service without permission or leaving assigned area for extended period of time. Sleeping while on duty. Harassment of any form. Coercing or harassing patients, employees, volunteers or guest. Malicious practical joking /horseplay. Reviewing, accessing or revealing confidential information. Deliberate oral or physical abuse of a patient, guest, volunteer or employee. Willful violation of safety regulations. Possession of firearm or weapon on hospital property. Consumption or possession of alcohol or drugs on hospital property. Falsification of time and attendance records. Smoking on hospital campus. Inappropriate oral, written or physical conduct of a sexual or threatening nature. PLEASE RETAIN FOR YOUR RECORDS 11 P age

Junior Volunteer Program

Junior Volunteer Program 5126 Hospital Drive Covington, GA 30014 Tel: 770.788.6553 Alecia.Brooks@piedmont.org Junior Volunteer Program Information Packet Piedmont Newton Hospital Volunteer Services Summer 2018 June 5 July 20 1

More information

Dear Volunteen Applicant:

Dear Volunteen Applicant: Dear Volunteen Applicant: Thank you for your interest in volunteering at Marian Regional Medical Center. Our Volunteen Program is for current high school students who are at least 14 years old. Please

More information

If you are currently a High School Senior. you will complete a general volunteer application, not this one.

If you are currently a High School Senior. you will complete a general volunteer application, not this one. 2018 North Cypress Medical Center Junior Volunteer Packet Must be a Current High School Sophomore or Junior If you are currently a High School Senior you will complete a general volunteer application,

More information

2013 Teen Volunteer Program

2013 Teen Volunteer Program 2013 Teen Volunteer Program Volunteer Services Office Dear Teen, Thank you for your interest in volunteering at. Students chosen to serve in our hospital will be those who can best represent our hospital

More information

Dear Prospective TeenAge Volunteer,

Dear Prospective TeenAge Volunteer, 1900 Don Wickham Dr. Clermont, FL 34711 tel 352.394.4071 SouthLakeHospital.com Dear Prospective TeenAge Volunteer, Thank you for your interest in the Teenage Volunteer Program at South Lake Hospital. Teenage

More information

Applicant Name: First Middle Last. Age: Birth Date: Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code

Applicant Name: First Middle Last. Age: Birth Date: Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code PLEASE PRINT : Applicant Name: First Middle Last Age: Birth : Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code (Applicant s) E-mail address: / Applicant s Parent s Legal Guardian/Mother/Father

More information

Application Deadline is Thursday April 13, Complete (include

Application Deadline is Thursday April 13, Complete (include 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

More information

Bonnie Butler-Sibbald. Dear Volunteer Applicant:

Bonnie Butler-Sibbald. Dear Volunteer Applicant: VOLUNTEER SERVICES Telephone (818) 409-7781 Facsimile Dear Volunteer Applicant: Thank you for your interest in the volunteer opportunities at Glendale Memorial Hospital and Health Center (GMHHC). Please

More information

Nash Health Care Junior Volunteer Application Packet

Nash Health Care Junior Volunteer Application Packet We are delighted that you are interested in joining the Junior Volunteer Program here at Nash Health Care. This program offers students, ages 15-18, the opportunity to work in a professional environment

More information

JUNIOR VOLUNTEER SERVICE

JUNIOR VOLUNTEER SERVICE Application is due by April 30 th. Interviews conclude May 18 th Selections made May 31 st Program begins June 4 th Program concludes July 31 st JUNIOR VOLUNTEER SERVICE Thank you for inquiring about the

More information

Junior Volunteer 2018 Summer Program Application (This is a 9 week program starting June 11 th and ending August 10 th )

Junior Volunteer 2018 Summer Program Application (This is a 9 week program starting June 11 th and ending August 10 th ) The following information will help us become better acquainted with you. We are especially interested in your qualifications and interest as a prospective volunteer. PLEASE PRINT. Please return this completed

More information

Junior/Teen Volunteer Program

Junior/Teen Volunteer Program Junior/Teen Volunteer Program Dear Prospective Junior/Teen Volunteer: Enclosed you will find information and forms to complete to become a Junior/Teen Volunteer. The Junior/Teen Volunteer Program is a

More information

Thank you for your interest in Stamford Hospital s Junior Volunteer Program. To participate in this program, you must be at least 14 years old.

Thank you for your interest in Stamford Hospital s Junior Volunteer Program. To participate in this program, you must be at least 14 years old. Dear Prospective Junior Volunteer, Thank you for your interest in Stamford Hospital s Junior Volunteer Program. To participate in this program, you must be at least 14 years old. Please read the directions

More information

Dear prospective FUN volunteer,

Dear prospective FUN volunteer, Dear prospective FUN volunteer, Thank you for your interest in the FUN volunteer program at Fernbank Museum of Natural History. FUN volunteers are essential to many of our educational programs, as well

More information

MINOR Volunteer Application

MINOR Volunteer Application MINOR Volunteer Application (15 years and younger) Parent/Guardian/Legal Custodian Permission for Minor to participate in BPHI Volunteer Program and Consent for Emergency Medical treatment. Broward County

More information

Children s Hospital Los Angeles Application for Summer Junior Volunteer Program 2018 (15-17 years of age)

Children s Hospital Los Angeles Application for Summer Junior Volunteer Program 2018 (15-17 years of age) Children s Hospital Los Angeles Application for Summer Junior Volunteer Program 2018 (15-17 years of age) Dear Volunteer Applicant: Thank you for your interest in becoming a Junior Volunteer at Children

More information

HIGH-SCHOOL STUDENT VOLUNTEER PROGRAM

HIGH-SCHOOL STUDENT VOLUNTEER PROGRAM HIGH-SCHOOL STUDENT VOLUNTEER PROGRAM 2017-2018 School Year Volunteer Application Becoming part of the NUMC volunteer team is a process and has many steps. Please review all the information carefully with

More information

3. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached).

3. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached). Volunteer Services Thank you for your interest in volunteering and in serving the patients and families of DeKalb Medical. Listed below are the steps in our application process: 1. Fill out our application

More information

Beo Nurse Aide Training Program

Beo Nurse Aide Training Program Policy for Admission to Program Beo Nurse Aide Training Program 1. Applicants to BEO Nurse Aide Training program must be 18 years of age, enrolled in High School at the Senior level or have a GED. 2. Admission

More information

Volunteer Infant Caregiver Description

Volunteer Infant Caregiver Description 4579 Northgate Court Sarasota, FL 34234 941-552-2065 Fax: 941-953-4673 Volunteer Application Local Address: Zip: Telephone: E-mail address: Residency Information (Please circle) Are you in the area Year

More information

STEPS FOR COMPLETING THE SERVICE LEARNING PACKET PLEASE READ ALL of the information contained in this document carefully.

STEPS FOR COMPLETING THE SERVICE LEARNING PACKET PLEASE READ ALL of the information contained in this document carefully. STEPS FOR COMPLETING THE SERVICE LEARNING PACKET PLEASE READ ALL of the information contained in this document carefully. Fully and accurately complete the three requirements outlined for the CAVE Service

More information

New Volunteer Candidate Processing Form

New Volunteer Candidate Processing Form Last Name First Name New Volunteer Candidate Processing Form (DO NOT WRITE ON THIS PAGE FOR OFFICE USE ONLY) Application Picture I.D. Procedure Working Papers (If under 18 yrs.) Personal Reference Physical

More information

2017 VolunTEEN Scheduling Form. SHIRT SIZE: S M L XL XXL **sizes run big

2017 VolunTEEN Scheduling Form. SHIRT SIZE: S M L XL XXL **sizes run big 2017 VolunTEEN Scheduling Form NAME: PHONE #: SHIRT SIZE: S M L XL XXL **sizes run big Indicate below your preference of shift by numbering the blocks by 1 st, 2 nd and 3 rd choice. If you have two first

More information

Adult Volunteer Application

Adult Volunteer Application Adult Volunteer Application Dear Community Friend: Thank you for your interest in volunteering at Slidell Memorial Hospital (SMH). Volunteering can be quite rewarding and, of course, is a great help to

More information

ICM Food & Clothing Bank Volunteer Application

ICM Food & Clothing Bank Volunteer Application Please print legibly. Date: / _/ ICM Food & Clothing Bank Volunteer Application Name: Email: Tel: ( ) Cell: ( ) Address: City: State: Zip: Emergency Contact Tel: 1. How did you hear about ICM? (i.e., school,

More information

2018 Junior Volunteer Application (Please PRINT Use either blue or black ink All information must be completed by Junior Applicant)

2018 Junior Volunteer Application (Please PRINT Use either blue or black ink All information must be completed by Junior Applicant) Office Use Only Received By: Date Received: / /. Complete Incomplete Interviewed By: Date Interviewed: Accepted Not Accepted 2018 Junior Volunteer Application (Please PRINT Use either blue or black ink

More information

2. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached).

2. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached). Volunteer Services Thank you for your interest in volunteering and in serving the patients and families of DeKalb Medical. Listed below are the steps in our application process: 1. Fill out our application

More information

MARITIME COLLEGE STATE UNIVERSITY OF NEW YORK

MARITIME COLLEGE STATE UNIVERSITY OF NEW YORK MARITIME COLLEGE STATE UNIVERSITY OF NEW YORK Counselor in Training Handbook and Application 2017 I. Program Objective SUNY Maritime College s Waterfront Department Counselor in Training (CIT) Program

More information

YOUTH VOLUNTEERS. Dear Parent and Prospective Camp Teen Volunteer:

YOUTH VOLUNTEERS. Dear Parent and Prospective Camp Teen Volunteer: YOUTH VOLUNTEERS Dear Parent and Prospective Camp Teen Volunteer: Thank you for your interest in the Zoo Miami Foundation Camp Teen Volunteer program! The Zoo Miami Foundation Camp Teen Volunteer program

More information

Please feel free to contact me at (410) if you have any questions regarding your application. Thanks again for thinking of Sinai Hospital!

Please feel free to contact me at (410) if you have any questions regarding your application. Thanks again for thinking of Sinai Hospital! July 2017 Dear Student, Thank you for your interest in Sinai Hospital s Student Fall Volunteer Program! As a healthcare family dedicated to our community, we are excited to help facilitate your hands-on

More information

Must provide copy of college/university enrollment confirmation.

Must provide copy of college/university enrollment confirmation. College Healthcare Volunteer Applicants: Thank you for your interest in the College Healthcare Volunteer Program in the ER at Memorial Hermann Katy Hospital during the period of June 4 July 29, 2018. We

More information

Alpharetta Recreation and Parks Department 2018 Wills Park Summer Day Camp Counselor In Training Handbook

Alpharetta Recreation and Parks Department 2018 Wills Park Summer Day Camp Counselor In Training Handbook Alpharetta Recreation and Parks Department 2018 Wills Park Summer Day Camp City of Alpharetta Recreation and Parks Alpharetta Community Center 175 Roswell Street Alpharetta, GA 30009 (678) 297-6100 accprograms@alpharetta.ga.us

More information

STUDENT VOLUNTEER APPLICATION *Minimum Age for volunteers is 16*

STUDENT VOLUNTEER APPLICATION *Minimum Age for volunteers is 16* STUDENT VOLUNTEER APPLICATION *Minimum Age for volunteers is 16* CONTACT INFORMATION Name: Date: Address: Home Phone: Cell Phone: Email: Over 16? Over 18? EMERGENCY CONTACT INFORMATION Emergency Contact:

More information

WELCOME TO VOLUNTEER SERVICE

WELCOME TO VOLUNTEER SERVICE WELCOME TO VOLUNTEER SERVICE Dear New Volunteer, It is a sincere pleasure to welcome you to the Volunteer Service of Memorial Hermann Prevention and Recovery Center (PaRC). The men and women who volunteer

More information

New Volunteer Candidate Processing Form

New Volunteer Candidate Processing Form Last Name First Name New Volunteer Candidate Processing Form (DO NOT WRITE ON THIS PAGE FOR OFFICE USE ONLY) Procedure Application Picture I.D. Working Papers (If under 18 yrs.) Reference #1 Personal Reference

More information

Polk County Sheriff s Office

Polk County Sheriff s Office Polk County Sheriff s Office Explorer Post 900 Application Grady Judd, Sheriff Polk County Sheriff s Office 1891 Jim Keene Blvd Winter Haven, FL 33880 (863) 298-6200 www.polksheriff.org Pride In Service

More information

Roosevelt Care Center. Volunteer Service Application

Roosevelt Care Center. Volunteer Service Application Volunteer Service Application Name : : City, State, Zip Code: Home phone #: Cell phone# In Case of Emergency, please notify: Phone # Relationship: of last PPD (Tuberculosis skin test) Have you had: Mumps

More information

ILLINOIS CHARTERED ASSOCIATION OF DECA

ILLINOIS CHARTERED ASSOCIATION OF DECA ILLINOIS CHARTERED ASSOCIATION OF DECA CONDUCT, DRESS CODE & EMERGENCY INFORMATION FOR ALL DECA ACTIVITIES Attendance at any DECA sponsored conference or activity is a privilege. The following conduct

More information

Must provide copy of college/university enrollment confirmation. Must complete College Student Volunteer Application and Volunteer Agreement Forms.

Must provide copy of college/university enrollment confirmation. Must complete College Student Volunteer Application and Volunteer Agreement Forms. COLLEGE STUDENT VOLUNTEER APPLICATION: Thank you for your interest in the College Student Volunteer Program at Memorial Hermann. We receive many applications and accept students based on their application,

More information

To begin the application process, please complete the enclosed application and bring it with you to one of our weekly meetings.

To begin the application process, please complete the enclosed application and bring it with you to one of our weekly meetings. Dear Explorer Applicant, We are pleased that you have shown interest in the Miramar Police Department Explorer Program. The Explorer program is the best program that young men and women can become involved

More information

Written applications for admission are accepted year round and qualified applicants will be placed in appropriate class.

Written applications for admission are accepted year round and qualified applicants will be placed in appropriate class. 835 Ferry Street Martinez CA 94553 925-293-4792 Loaves and Fishes of Contra Costa ( LFCC ) Culinary Training Program ( CTP ) The Loaves and Fishes Culinary Training Program is a five-week (@70-100 hours)

More information

Application for Admission Nurse Aide Training Program

Application for Admission Nurse Aide Training Program Med-Cert Training Center Maple Heights Med-Cert Training Center AKRON 5416 Northfield Road 771 North Main Street Maple Heights, OH 44137 Akron, OH 44310 Phone (440) 786-2378, Fax (440) 786-7327 1-877-514-2378

More information

HALESITE FIRE DEPARTMENT

HALESITE FIRE DEPARTMENT HALESITE FIRE DEPARTMENT Junior Firefighter Program BY - LAWS November 25, 2014 Page 1 of 9 Halesite Fire Department Junior Firefighter Program By-Laws ARTICLE I: TITLE AND MISSION STATEMENT SECTION I:

More information

Emory Johns Creek Hospital

Emory Johns Creek Hospital Dear Applicant: Thank you for your interest in the 2018 Summer VolunTEEN Program. Due to the large number of students interested in the Program, it is essential that you pay close attention to the information

More information

VOLUNTEER APPLICATION

VOLUNTEER APPLICATION Thank you for your interest in Estes Park Medical Center. The mission of the Estes Park Medical Center is to make a positive difference in the health and wellbeing of all we serve. VOLUNTEER APPLICATION

More information

bring it with you to your scheduled interview (do not submit this with your application);

bring it with you to your scheduled interview (do not submit this with your application); Dear Volunteer Applicant: Thank you for your interest in the Volunteer Services program at Carolinas HealthCare System Lincoln. Joining the dedicated team of adult and teen volunteers can be a richly rewarding

More information

If you have any questions, please direct them to the District Volunteer Office at (916)

If you have any questions, please direct them to the District Volunteer Office at (916) Dear Volunteer, We are pleased that you have decided to participate in the Sacramento City Unified School District (SCUSD) Volunteer Program! As parents, grandparents, neighbors and community members you

More information

Application for Admission Nurse Aide Training Program

Application for Admission Nurse Aide Training Program Med-Cert Training Center Maple Heights Med-Cert Training Center AKRON 5416 Northfield Road 733 West Market Street, Suite 101 Maple Heights, OH 44137 Akron, OH 44303 Phone (440) 786-2378, Fax (440) 786-7327

More information

JUNIOR AMBASSADOR SUMMER PROGRAM APPLICATION Age: Date of Birth: Parent/Guardian s

JUNIOR AMBASSADOR SUMMER PROGRAM APPLICATION Age: Date of Birth:   Parent/Guardian s JUNIOR AMBASSADOR SUMMER PROGRAM APPLICATION - 2016 Name: (Last) (First) (Middle) Date: Address: (Street) (City) (State) (Zip Code) Phone: (H) (C) Age: Date of Birth: E-mail: Parent/Guardian s Email: High

More information

We look forward to meeting and learning more about you! ~ St. Luke s Volunteer Leadership Team

We look forward to meeting and learning more about you! ~ St. Luke s Volunteer Leadership Team DEPARTMENT OF VOLUNTEER SERVICES Dear Prospective Volunteer: Thank you for your interest in our volunteer program! We believe you will find volunteering for St. Luke's University Health Network to be a

More information

Please return your completed application to

Please return your completed application to Dear Potential Volunteer, Thank you for your interest in volunteering with Charlotte Pediatric Clinic. Volunteers are an important part of our team and help us in many ways. We appreciate everyone who

More information

Future Business Leaders of America - Arizona 1535 West Jefferson Street Phoenix, AZ Phone: (602) Fax: (602)

Future Business Leaders of America - Arizona 1535 West Jefferson Street Phoenix, AZ Phone: (602) Fax: (602) Future Business Leaders of America - Arizona 1535 West Jefferson Street Phoenix, AZ 85007 www.azfbla.org Phone: (602) 542-5350 Fax: (602) 542-1849 Congratulations! You have taken the first step towards

More information

STUDENT VOLUNTEER PROGRAM. HIGH SCHOOL STUDENT Application Packet Part 2

STUDENT VOLUNTEER PROGRAM. HIGH SCHOOL STUDENT Application Packet Part 2 STUDENT VOLUNTEER PROGRAM HIGH SCHOOL STUDENT Application Packet Part 2 INSTRUCTIONS FOR APPLYING Part 2 Application Procedural Steps: 1. Complete the RBA Staffing Solutions Reference Checking Authorization

More information

YOUTH VOLUTEERS. Dear Parent and Prospective Teen Volunteer:

YOUTH VOLUTEERS. Dear Parent and Prospective Teen Volunteer: YOUTH VOLUTEERS Dear Parent and Prospective Teen Volunteer: Thank you for your interest in the Zoo Miami Foundation Teen Volunteer program! The Zoo Miami Foundation Teen Volunteer program is an exciting

More information

District Handbook for Club Presidents and RYLA Chair Persons Rotary District Dave Stuckey, Chair

District Handbook for Club Presidents and RYLA Chair Persons Rotary District Dave Stuckey, Chair 2018 District 7710 Handbook for Club Presidents and RYLA Chair Persons Rotary District 7710 Dave Stuckey, Chair 1 Table of Contents What is RYLA?. 3 Application Procedures 4 Selection Criteria. 5 What

More information

Individual Volunteer Application

Individual Volunteer Application Individual Volunteer Application This application is for individuals only. Once you submit this application, the Director of Volunteer Services and Community Outreach will contact you regarding your approval

More information

Allen County Police Cadet Program Application Packet. Sheriff David J. Gladieux

Allen County Police Cadet Program Application Packet. Sheriff David J. Gladieux Allen County Police Cadet Program Application Packet 15 Allen County s Department Introduction: Thank you for your interest! The Allen County Police Cadet program is one of a kind; there are no other local

More information

Matlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL APPLICATION FOR EMPLOYMENT

Matlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL APPLICATION FOR EMPLOYMENT Position(s) Applied For Matlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL 33922 APPLICATION FOR EMPLOYMENT Date of Application PERSONAL INFORMATION Last Name First Name Middle

More information

Oregon State University School of Biological and Population Health Sciences KIN 344: Pre-Therapy/Allied Health Practicum.

Oregon State University School of Biological and Population Health Sciences KIN 344: Pre-Therapy/Allied Health Practicum. KIN 344: Pre-Therapy/Allied Health Practicum Checklist Obtain application packet and read all enclosed information Complete the Application Form Complete the Immunization Form Attach copies of medical

More information

THE 2014 AMERICAN RED CROSS SUMMER YOUTH VOLUNTEER PROGRAM AT THE EVANS ARMY COMMUNITY HOSPITAL FORT CARSON, COLORADO May 27 July 25

THE 2014 AMERICAN RED CROSS SUMMER YOUTH VOLUNTEER PROGRAM AT THE EVANS ARMY COMMUNITY HOSPITAL FORT CARSON, COLORADO May 27 July 25 THE 2014 AMERICAN RED CROSS SUMMER YOUTH VOLUNTEER PROGRAM AT THE EVANS ARMY COMMUNITY HOSPITAL FORT CARSON, COLORADO May 27 July 25 The American Red Cross (ARC) at Fort Carson s Evans Army Community Hospital

More information

Kaiser Permanente Youth Exploration Academy in Healthcare (KP YEAH!)

Kaiser Permanente Youth Exploration Academy in Healthcare (KP YEAH!) Kaiser Permanente Youth Exploration Academy in Healthcare (KP YEAH!) APPLICATION OVERVIEW KP Youth Exploration Academy in Healthcare (KP YEAH!) is a paid, 4 week-long, interactive exploration program for

More information

SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET

SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET Dear Applicant, Thank you for your interest in the Milwaukee Ballet Summer Intensive Resident Assistant Position. Resumes will be collected until

More information

We are excited to help you through the process to become a volunteer here at Northside Hospital Cherokee and look forward to meeting you soon.

We are excited to help you through the process to become a volunteer here at Northside Hospital Cherokee and look forward to meeting you soon. Dear Prospective Volunteer: Thank you for your interest in the volunteer program at Northside Hospital Cherokee. We are proud of the volunteer services here at Northside Cherokee. Our members come from

More information

Fairfield Medical Center volunteers serve in a wide variety of departments and are valued members of our healthcare team.

Fairfield Medical Center volunteers serve in a wide variety of departments and are valued members of our healthcare team. Thank you for your interest in the Fairfield Medical Center Volunteer Services Program. Enclosed is an application that will provide information to assist us in making the best use of your interests and

More information

Clinical Probation. Tammy Mangold, MEd, CST/CFA Director Surgical Technology, Rolla Technical Center

Clinical Probation. Tammy Mangold, MEd, CST/CFA Director Surgical Technology, Rolla Technical Center Clinical Probation By Tammy Mangold, MEd, CST/CFA Director Surgical Technology, Rolla Technical Center 1 Within the program several types of probation should be established. These may include: academic,

More information

Healthy Texas Youth Ambassador. Information Handbook

Healthy Texas Youth Ambassador. Information Handbook 2018-19 Healthy Texas Youth Ambassador Information Handbook Table of Contents Purpose... 3 Eligibility Requirements/Program Objectives... 3 Attendance Policy... 4 Activity Requirements... 4 Dress Code..5

More information

Helping others grow and excel through their interaction with horses 3498 Barclay Messerly Road Southington, Ohio 44470

Helping others grow and excel through their interaction with horses 3498 Barclay Messerly Road Southington, Ohio 44470 Dear Prospective Volunteer: Helping others grow and excel through their interaction with horses 3498 Barclay Messerly Road Southington, Ohio 44470 Ph. (330) 889-0036 www.thecamelotcenter.org ==============================================================

More information

Washington County Tennessee Sheriff s Office. Ed Graybeal, Sheriff. Employment Application Packet

Washington County Tennessee Sheriff s Office. Ed Graybeal, Sheriff. Employment Application Packet Washington County Tennessee Sheriff s Office Ed Graybeal, Sheriff Employment Application Packet PLEASE READ CAREFULLY AND ANSWER ALL QUESTIONS COMPLETELY. INCLUDE A COPY OF YOUR DRIVER S LICENSE, BIRTH

More information

We are delighted that you have expressed an interest in becoming a volunteer at Bryn Mawr Hospital!

We are delighted that you have expressed an interest in becoming a volunteer at Bryn Mawr Hospital! Dear Community Member: We are delighted that you have expressed an interest in becoming a volunteer at Bryn Mawr Hospital! Volunteers are our most valuable asset, performing a variety of non-medical services

More information

Kaiser Permanente Northwest KP YEAH!

Kaiser Permanente Northwest KP YEAH! Kaiser Permanente Youth Exploration Academy in Healthcare (KP YEAH!) Application Overview KP Youth Exploration Academy in Healthcare (KP YEAH!) is a paid, four week-long, interactive exploration program

More information

Volunteer Application

Volunteer Application Volunteer Application Applicant Information First Name: Middle Initial: Last Name: Address: City: State: Zip: Home Phone: Cell Phone: Email: Occupation: Special Skills: Volunteer Preferences Have you previously

More information

How to Apply. Volunteer Services. Becoming a volunteer. Requirements. Training. Uniform. Apply today!

How to Apply. Volunteer Services. Becoming a volunteer. Requirements. Training. Uniform. Apply today! Volunteer Services How to Apply Becoming a volunteer We invite you to join our team! To pursue a volunteer position at Providence, here are the steps you need to take: 1. Fill out the application and return

More information

Camp TOV Medical Form

Camp TOV Medical Form Mail: Fax: Please send these forms to us by either: Jewish United Fund/Jewish Federation of Metropolitan Chicago Attn: Camp TOV 30 South Wells Street, Room 5034 Chicago, IL 60606 Attn: Camp TOV 312-444-2086

More information

City of Pasadena HOW TO GET INVOLVED: Parks and Recreation Department. Adaptive Recreation Division: Verne Cox Multipurpose Recreation Center (VCMRC)

City of Pasadena HOW TO GET INVOLVED: Parks and Recreation Department. Adaptive Recreation Division: Verne Cox Multipurpose Recreation Center (VCMRC) 2018 City of Pasadena Parks and Recreation Department Adaptive Recreation Division: Verne Cox Multipurpose Recreation Center (VCMRC) HOW TO GET INVOLVED: Completely review, fill out and sign this packet.

More information

Handbook for Club Presidents and RYLA Chair Persons Rotary District Dave Stuckey, Chair

Handbook for Club Presidents and RYLA Chair Persons Rotary District Dave Stuckey, Chair 2017 Handbook for Club Presidents and RYLA Chair Persons Rotary District 7710 Dave Stuckey, Chair 1 Table of Contents What is RYLA?... 3 Application Procedures...4 Selection Criteria... 5 Info to share

More information

SAISD Volunteer Information Packet

SAISD Volunteer Information Packet SAISD Volunteer Information Packet Thank you for choosing to volunteer in the San Antonio Independent School District. We hope that the time that you spend volunteering at SAISD is both fun and rewarding.

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT 895 Mary Dunn Road, Hyannis, MA 02601 (508) 778.5040 Fax: (508) 778.9642 www.capeabilities.org Accredited by The Commission on Accreditation of Rehabilitation Facilities Thank

More information

In order to qualify as a Member of the Flagler Hospital Auxiliary, volunteers shall:

In order to qualify as a Member of the Flagler Hospital Auxiliary, volunteers shall: FLAGLER HOSPITAL INC. 400 Health Park Blvd. St. Augustine, FL 32086 904-419-4411 Dear Future Volunteer: Thank you for your interest in serving as a volunteer with the Flagler Hospital Auxiliary. We offer

More information

Vidant Beaufort Hospital Junior Volunteer Application 2018

Vidant Beaufort Hospital Junior Volunteer Application 2018 Vidant Beaufort Hospital Junior Volunteer Application 2018 Please direct any questions to: Volunteer Services Vidant Beaufort Hospital 628 E. 12 th Street Washington, NC 27889 975-4161 Completed application

More information

*** Program Guidelines ***

*** Program Guidelines *** *** Program Guidelines *** *The Junior Volunteer program has a limited number of available positions. Placement decisions will be based upon first come, first serve. Volunteers must be at least 15 years

More information

Angela Max Maxwell. Dear Prospective Volunteers and Interns,

Angela Max Maxwell. Dear Prospective Volunteers and Interns, Dear Prospective Volunteers and Interns, Thank you for your interest in The Bunny Hutch Boutique and CLIMATES-Rescue. Our volunteers and interns are a precious resource. Interns and Volunteers contribute

More information

BON SECOURS DEPAUL MEDICAL CENTER

BON SECOURS DEPAUL MEDICAL CENTER BON SECOURS DEPAUL MEDICAL CENTER 150 Kingsley Lane, Norfolk Virginia 23505 Main Number: 757-889-5000 Volunteer Office: 757-889-5340 VOLUNTEER SERVICES Orientation Agenda I. Welcome II. Objective TO BE

More information

APPLICATION FOR ADMISSION

APPLICATION FOR ADMISSION APPLICATION FOR ADMISSION UPMC SCHOOLS OF NURSING APPLICATION FOR ADMISSION The following schools are part of the UPMC Schools of Nursing. Please list in order of preference which school of nursing you

More information

Camp JRA will be held at Camp Victory in Millville, PA, from July 19-24, Counselors are required to attend staff orientation on July 18 th.

Camp JRA will be held at Camp Victory in Millville, PA, from July 19-24, Counselors are required to attend staff orientation on July 18 th. Dear Prospective Counselor, Thank you for your interest in being a Camp JRA (Juveniles Reaching Achievement) counselor. We are excited to be planning for a fun-filled week for our campers in 2015. Camp

More information

If at any time you would like to know the status of your application please Maria Strmsek or April Garcia at the addresses listed below.

If at any time you would like to know the status of your application please  Maria Strmsek or April Garcia at the  addresses listed below. Dear Volunteer Applicant: Thank you for your interest in volunteering at Henry Mayo Newhall Hospital. Please review the Volunteer application and our Eligibility and Requirements. Return the COMPLETED

More information

Angelica Srivoraphan Business Development Coordinator Volunteer Services Leader Carolinas Rehabilitation Carolinas HealthCare System

Angelica Srivoraphan Business Development Coordinator Volunteer Services Leader Carolinas Rehabilitation Carolinas HealthCare System 2015 Dear Shadow Applicant: Thank you for your interest in the shadow program at Carolinas Rehabilitation. The shadow program will be a richly rewarding experience for you and I hope that you will find

More information

2017 Perry Hall High School Marching Band Camp Counselor Registration

2017 Perry Hall High School Marching Band Camp Counselor Registration 2017 Perry Hall High School Marching Band Camp Counselor Registration If you are reading this packet then you have the opportunity to carry on your legacy by becoming a marching band counselor. Graduates

More information

Region Officer Handbook and Application

Region Officer Handbook and Application 2014-2015 Region Officer Handbook and Application Georgia FCCLA 283 Swanson Drive Suite # 204 Lawrenceville, GA 30043 Office (678) 735-0091 Fax (678) 735-0094 www.gafccla.com 1 Table Of Contents General

More information

A & L Home Care and Training Center, LLC. ***Important Information***

A & L Home Care and Training Center, LLC. ***Important Information*** ***Important Information*** Physical Competed physical form must be submitted to A & L Home Care and Training Center, LLC by the first day of class. **Your Physical cannot be more than 6 months old.**

More information

2018 East Texas Rural Electric Youth Seminar

2018 East Texas Rural Electric Youth Seminar 2018 East Texas Rural Electric Youth Seminar June 25 June 29, 2018 on the East Texas Baptist University (ETBU) campus in Marshall, Texas Applications due Friday, April 20, 2018. To qualify please complete

More information

VOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT

VOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT Updated: 6/29/17 VOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT Return Completed Application to: 510 Cinnamon Drive, Satellite Beach, FL 32937 Personal Information Last Name: First Name: MI: Home

More information

EQUINE PROGRAM SUMMER VOLUNTEER APPLICATION HOME PHONE: T-SHIRT SIZE (circle one): SMALL MEDIUM LARGE X-LARGE XX-LARGE

EQUINE PROGRAM SUMMER VOLUNTEER APPLICATION HOME PHONE: T-SHIRT SIZE (circle one): SMALL MEDIUM LARGE X-LARGE XX-LARGE EQUINE PROGRAM SUMMER VOLUNTEER APPLICATION VOLUNTEER NAME: BIRTH DATE: / / MAILING ADDRESS: CITY: STATE: ZIP: CELL PHONE: HOME PHONE: EMIAL ADDRESS: T-SHIRT SIZE (circle one): SMALL MEDIUM LARGE X-LARGE

More information

Name Date (First) (MI) (Last Address (Street) (City) (State) (Zip) Phone Parent s Name. Birth Date: Age School Present Grade.

Name Date (First) (MI) (Last Address (Street) (City) (State) (Zip) Phone Parent s Name. Birth Date: Age   School Present Grade. JUNIOR VOLUNTEER APPLICATION Perth Amboy Old Bridge Perth Amboy 530 New Brunswick Avenue One Hospital Plaza Old Bridge Perth Amboy, N.J. 08861 Old Bridge, N.J. 08857 (732)442-3700 (732)360-1000 Name Date

More information

Diocese of San Jose Personnel Department School Year. Dear Teacher Applicant:

Diocese of San Jose Personnel Department School Year. Dear Teacher Applicant: Diocese of San Jose Personnel Department 1999-2000 School Year Dear Teacher Applicant: Thank you for expressing interest in employment with the Diocese of San Jose. We want to be able to give the principals

More information

225 Williamson Street Elizabeth, NJ Name: Last First. Home Address: City State Zip Code

225 Williamson Street Elizabeth, NJ Name: Last First. Home Address: City State Zip Code 225 Williamson Street Elizabeth, NJ 07207 APPLICATION FOR MEDICAL MENTOR PROGRAM AT TRMC Name: Last First : Home Address: City State Zip Code of Birth: Home Phone: Are you Male or Female? (circle one)

More information

CARING Experts ADVANCED Technology HEALTHIER Lives

CARING Experts ADVANCED Technology HEALTHIER Lives P CARING Experts ADVANCED Technology HEALTHIER Lives Complete & Return this form APPLICATION Adult Date: College Student VOLUNTEER High School Student Name First Middle Last Home Phone Street Address Cellular

More information

Thank you for requesting information about Connection of Friends Internship Program.

Thank you for requesting information about Connection of Friends Internship Program. Dear Intern Applicant, Thank you for requesting information about Connection of Friends Internship Program. Connection of Friends was created to provide structured programming for participants while encouraging

More information

SPECTACULAR All Camp Policies and Expectations

SPECTACULAR All Camp Policies and Expectations SPECTACULAR All Camp Policies and Expectations Our mission is to provide a safe, Christ centered community that encourages young women and men to discover God, their inherent worth and cultivate and express

More information

Hands that serve.hearts that care.

Hands that serve.hearts that care. Hands that serve.hearts that care. Dear Applicant, We are excited that you are interested in volunteering at The University of Mississippi Medical Center (UMMC) and we want to make your volunteering experience

More information

Dear Prospective Volunteer,

Dear Prospective Volunteer, Dear Prospective Volunteer, Thank you for your interest in volunteering at Sinai Hospital! As a healthcare facility dedicated to our patients and our community, we are always looking for individuals to

More information