Request to Volunteer at Renown Renown Health

Please check the appropriate box

Adult Volunteer
College Volunteer
High School Volunteer
Other

If other, please specify.

First Name*

Middle Name*

Last Name*

Name

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Please include apartment, unit or suite number if applicable.

Home Phone Number

Cell Phone Number*

Email*

Driver's License Number or other Government Issued ID*

Last four numbers of Social Security*

Date of Birth*

Gender

Highest year of education completed

College

School Name (Full-time or Part-time)

Expected Grad. Date

Major

Are you currently employed?

Yes
No

Present Occupation or Title

Area(s) of interest

Renown Regional
Senior Care Plus (for members of Senior Care Plus only)
Skilled Nursing
South Meadows
Other

If other, please list.

VOLUNTEER TIME REQUIREMENTS AND AVAILABILITY

Minimum Commitment: Commit to a twelve (12) month period, able to work one shift per week. College and Adult volunteers are required to work one 4-hour shift and current high school students are required to work one 2-hour shift per week. Availability to volunteer during the timeframe of Monday - Friday 7am- 7pm Requirements Subject to Change

What days of the week are you available?

Monday
Tuesday
Wednesday
Thursday
Friday

What is your availability on Mondays?

What is your availability on Tuesdays?

What is your availability on Wednesdays?

What is your availability on Thursdays?

What is your availability on Fridays?

Emergency Contact Information

Name*

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

General Information

In order for us to provide a satisfying experience for you in Volunteer Services, it helps to know a little more about you.

Please tell us about your hobbies, sports or special abilities, achievements, honors and/or awards.*

How did you hear about becoming a Renown Volunteer?*

What are your goals for volunteering at Renown Health?*

Eligibility

Are you a United States citizen or an alien authorized to work in the U.S.?*

Yes
No

Have you previously been an employee or volunteer for the Renown Health System?*

Yes
No

If yes, please state the organization, assignment, dates, status (employee or volunteer) and name while employed

Have you ever been convicted or found guilty by any court of a felony offense or any gross misdemeanor or simple misdemeanor offense other than a minor traffic offense?*

Yes
No

(“A conviction shall include a plea, verdict or finding of guilty…” Labor Code 432.7) A conviction will not necessarily disqualify an individual from the volunteer program. Driving under the influence of alcohol and/or drugs and reckless driving must be disclosed.

If Yes, please state the nature of each offense, the date of conviction and the disposition

Volunteer Acknowledgement & Agreement

As a Renown Health volunteer I agree to uphold the values of the organization by providing a high standard of quality service to our patients and staff. I agree to hold absolutely confidential all information that I may obtain directly or indirectly concerning patients, doctors, or personnel. I can be depended on to work my assigned shift and will call, in advance, if not able to fulfill that obligation. Three (3) no-call no-shows will result in termination from the program. I will commit to volunteering for the next twelve (12) months. I will wear the proper uniform as outlined in the orientation packet. I understand that I will be expected, before placement, to complete the volunteer orientation and required health screening.

By checking "I Agree", I acknowledge that I have read and understand the statements above. The information provided in this application is true in all respects without any willful omissions. I authorize Renown Health System to obtain a background check and a personal reference. 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 Agree
I Disagree

The organization is not obligated to provide a placement, nor are you obligated to accept the position offered. A volunteer position does not constitute an employee-employer relationship with the medical center.

Opportunities for volunteers are provided without regard to color, race, religion, age, creed, national origin, sex, disability, veteran or marital status. In accordance with the Immigration Reform and Control Act of 1986, all offers of service (volunteer) are conditional upon satisfactory proof of the applicant’s identity and legal ability to work in the United States.

Request to Volunteer at Renown

VOLUNTEER TIME REQUIREMENTS AND AVAILABILITY

Emergency Contact Information

General Information

Eligibility

Volunteer Acknowledgement & Agreement

How is Book Ahead Calculated?