All orientations are full; therefore, we are not accepting applications at this time. Please check back periodically for updates.

Transcription

1 Dear Prospective Volunteer, Thank you for your interest in volunteering at your community hospital! One of the requirements for becoming a Fairview Ridges Hospital volunteer is to attend a hospital orientation that will acquaint you with the hospital setting and the Junior Volunteer Program. Orientations will be held in the hospital s conference rooms A & B on: All orientations are full; therefore, we are not accepting applications at this time. Please check back periodically for updates. As a new Fairview volunteer, you will need to provide a copy of your immunization records, which includes Measles, Mumps, and Rubella (MMR) and Varicella (Chicken Pox). You will also need to receive a Tuberculosis skin test (Mantoux). You will receive detailed information about the volunteer health requirements during your orientation. Please fill out and return the bottom portion of this letter to Volunteer Services for orientation registration. If you have questions, please contact our office at See you at orientation! JUNIOR VOLUNTEER ORIENTATION REGISTRATION Space is limited, so respond quickly! Please PRINT! I will attend the following orientation: No orientations are scheduled at this time. Please check back periodically. Name: Phone: formsjunior Volunteer Orientation Letter _ doc

2 JUNIOR VOLUNTEER APPLICATION Fairview Ridges Hospital 201 East Nicollet Boulevard Burnsville, MN Volunteer Services PLEASE PRINT OR TYPE FULL LEGAL NAME Today s date: Name: (Last) (First) (Middle) Age: Date of Birth: Phone: Address: City State Zip address FOR OFFICE USE Application received Initial Contact Ack Interview By Health Review Assign Schedule Start Date Comments: Education: Grade in school Name of school Employment: Current Employer: Position: List work hours and days: Additional Information: To what school, church, or community organizations do you belong? List current or previous volunteer experience: Skills, interests, hobbies: Do you speak a foreign language? Sign language? (specify)

3 Please list names of any volunteers you may know here. How did you learn of the Fairview Ridges Junior Volunteer Program? Do you have any health problems that we should be aware of? No Yes (specify) Availability for volunteering: Morning Preferred day (s) Afternoon Evening Weekend Please specify what volunteer area (s) interest you: Prior to acceptance into the volunteer program, every applicant is required to complete a brief health history with Health Services. You may be required to take a mantoux test for TB and show proof of immunization history. Fairview Ridges is committed to the policy that all persons shall have equal treatment and opportunity in every aspect of our relationship with staff and volunteers without regard to race, color, religion, sex, national origin, age, marital status or physical handicap (except when based on a bonafide occupational qualification). Date Signature of applicant

4 Please have your parent complete the form below. My daughter / son has my consent to serve as a volunteer at Fairview Ridges Hospital. Parent signature Date In the event that my daughter / son should require medical attention while on duty as a volunteer, I understand that Fairview Ridges Hospital will first make every attempt to contact me through the emergency numbers listed below. Emergency contacts: Name Relationship Phone (H) (W) Name Relationship Phone (H) (W) If unable to make contact with anyone at the designated emergency numbers, I give my permission to Fairview Ridges Hospital to administer medical care/treatment to my son / daughter should he / she require medical services while on duty as a junior volunteer. Parent signature Date: WPDocs/JuniorFiles/JuniorVolunteerApplication

5 Reference for Junior Volunteer DATE APPLICANT ADDRESS PHONE SCHOOL TEACHER This student has applied to be a Junior Volunteer at Fairview Ridges Hospital. It will help us to evaluate this student s abilities and suitability for this kind of volunteer work if you will answer the following questions. According to your records and knowledge, please comment on the following traits: Attendance at school / punctuality Ability to learn / initiative Ability to follow through Ability to work with others Ability to prioritize and multi-task Respectful communication with others Additional comments TEACHER S SIGNATURE PHONE PARENTS: State and Federal legislation requires that schools must have parental consent to release information regarding students. Please sign this form and have your son or daughter turn it in to a teacher or school counselor. My daughter or son has my consent to serve as a volunteer at Fairview Ridges Hospital. Guardian Signature Teachers : RETURN REFERENCE FORM TO: Fairview Ridges Hospital/ Volunteer Services Q:\Southwest-Shares\FSH\ShareDir\Communications and Marketing\Julie Hennen Mikkelson\Julie's Jr ref. for application.doc folder\frh\volunteerhealthassess2008.doc Page 2 of 2 Revised August 2008