GVMC Volunteer Form | CAMC Health System

CAMC Greenbrier Valley Medical Center Volunteer Application

Title

First name

Last name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Primary phone number

Secondary phone number

Email address

Date of birth

Last four digits of SSN#

Education

Uniform size

Age range

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Gender

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Emergency contact

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

CAMC employee?

Have you ever been employed by CAMC? If so where did you work and what were your dates of employment?

Employer

Please list your current employer if applicable.

Skills

What kind of skills do you have that could be utilized as a volunteer at CAMC? Computer? Arts and Crafts? Interpersonal? Planning and Organization?

Core values

Tell me a little bit about yourself. Example: Goals, interests, hobbies. Why are you deciding to become a volunteer? Have you ever volunteered before? When? Where have you every been employed before? When? Where?

Availability

Monday

Tuesday

Wednesday

Thursday

Friday

All of the above

Please indicate the days you are available to volunteer. An important part of volunteering is commitment. Our volunteers play an important role in service to our patients, families, and staff. In order to provide the best service, we need our volunteers to be here on a regularly scheduled basis. Typically, we would like our volunteers to commit to at least 3 - 4 hours per week.

Criminal history

Have you ever plead guilty or 'no contest' to or been convicted of, violating any law with the exception of minor traffic violations?
If yes, please list your criminal convictions.

Terms and conditions

I certify that the answers given by me in the foregoing questions and statements are true and correct without consequential omissions. I understand and agree that any misrepresentation in my application will be sufficient cause for cancellation of the application and/or separation from the organization.

I understand that this is an application for volunteer services and not a contract to provide those services.

I will hold absolutely confidential all information which I may obtain directly or indirectly concerning patients, doctors or personnel. I will not seek confidential information in regard to a patient.

I give Charleston Area Medical Center, Inc. permission to make a thorough investigation that may include the following: past employment, past volunteer experiences, education, and criminal history. I authorize and release from liability or responsibility all persons, companies, schools and municipalities supplying any information regarding me whether or not it is a matter of record.

If selected as a volunteer, I understand that my services will be donated to CAMC Health System, Inc. without contemplation of compensation or future employment and given with humanitarian or charitable reasons.

I authorize CAMC Health System, Inc. to use and disclose information such as my name and photographs for the purposes of marketing, media and education.

As part of the volunteer onboarding process, I will be required to visit Employee Health for a health review and review of vaccinations. I understand I will be required to receive a flu shot annually. If you do not agree to these please do not submit this application.

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