JUNIOR VOLUNTEER PROGRAM

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1 JUNIOR VOLUNTEER PROGRAM To the Applicant: Thank you for your interest in becoming a Junior Volunteer. We are excited you are pursuing an interest in serving your community. The goal of the Junior Volunteer Program at Saline Memorial Hospital is to offer educational experiences, participation, and insight into the everyday operations of a community hospital as you explore your interest in a possible future career in the health care industry. The criteria for an applicant in the program are as follows: Must be between the ages of 14 and 18, having turned 14 prior to June 1, Must have at least a 3.0 grade point average. Be able to work at least three (3) days, for a minimum of twelve (12) hours each week during the six- week program. Have arranged transportation to and from the hospital during the program period. Be prepared to wear the required Junior Volunteer uniform at all times while performing services as a member of the Junior Volunteer Program consisting of red shirts (provided by SMH), khaki pants (no shorts), and closed- toe shoes (such as clean tennis shoes or loafers). Volunteer MUST be able to attend the required orientation scheduled for June 9, The deadline for application is June 2, 2014 and the following materials must be included: Completed Application Copy of Immunization Record Transcript $20.00 fee 2 Reference Letters- (Example: from teachers, principals, pastors, hospital personnel, family friends, etc.)

2 It is important that all items are received prior to the deadline to be considered for program participation. Upon receiving the application, a review committee will select the qualified candidates. In addition, you will be expected to have a TB skin test taken in accordance with the SMH employee/volunteer staff requirements. This test will be conducted at the hospital during orientation and at no cost to the volunteer. Junior Volunteers will have the opportunity to work in various areas of the hospital. Positions will be filled on a first come, first serve basis. The selection and assignment of Junior Volunteers will be based on the needs of the hospital and its departments. The program will run for six (6) weeks, starting June 9- July 17, Once again, I am very excited about your interest in volunteering. If you have any questions regarding the application process and/or the program itself, please do not hesitate to e- mail or call me. We look forward to having a great summer and I hope to see you here at Saline Memorial Hospital. Sincerely, Tammy Batchelor Director of Volunteer Services Saline Memorial Hospital 1 Medical Park Drive Benton, Ar Office (501) Cell (870) Please fill out the attached application and return it by June 2, 2014 Saline Memorial Hospital Attn: Volunteer Services 1 Medical Park Drive Benton, AR 72015

3 Junior Volunteer Program Participant Application Name: Address: City/State/Zip: Phone: E- mail: Date of Birth: School: Grade: GPA: Parent/Guardian: Daytime Phone: School and/or Religious Activities: Special Skills or Interests: Specialized Training (i.e. CPR certified) Previous Volunteer Experience: Page 1 of 3

4 How many hours per week will you be available for volunteer service? (Minimum of 12) Available Work Days: (check all that apply): Monday Tuesday Wednesday Thursday Shift Availability: 8am- Noon Noon- 4pm Note: It is important that you list any time period in which you will NOT be able to volunteer during the program- such as band camp, family vacations, mission trips, etc. to prevent your being scheduled for a shift in which you will not be able to volunteer. Please list any dates below: Shirt Size: (adult sizes): S M L XL XXL Is there a particular department or area of the hospital that you would like to volunteer in? Is there a particular department or area of the hospital that you would NOT like to volunteer in? (Please keep in mind that we will try to accommodate you with the workstation that you desire; however, the needs of the hospital will take priority.) Please list 3 personal references: Name Phone Number Page 2 of 3

5 Why do you want to volunteer? (Please attach additional page if more space is needed) Please read and sign: I hereby certify that the information provided on this application is true and correct. Should anything be found to be untrue, I understand that I will be subject to dismissal from the Junior Volunteer Program. In addition, I understand that the application and its requirements must be completed entirely to be considered for placement as a volunteer. Applicant Signature Date Parental Consent: I have read and fully understand the qualifications required for my child to participate in the Junior Volunteer Program at Saline Memorial Hospital and offer my consent for his/her participation. Parent s Signature Date Page 3 of 3

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