Dear Prospective Volunteer
I HAVE READ EACH OF THE ABOVE CONDITIONS AND I AGREE TO BE BOUND BY THEM
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- IMPORTANT! – Please contact your references and inform them that you are using them as references.
- If we are unable to obtain references, we cannot process your application.
- Please sign below, attesting that all the information you have provided in this application is accurate and true to the best of your knowledge. Signature
- IMPORTANT
- The individual noted above has applied for a volunteer position with AtlantiCare. Please complete the medical certification below
- Physician’s Printed Name
- JOB CODE: 815 EXEMPT: NON-EXEMPT: X DATE: 3/31/98
- QUALIFICATIONS EDUCATION
- EXPERIENCE
I HAVE READ EACH OF THE ABOVE CONDITIONS AND I AGREE TO BE BOUND BY THEM. Please print your name:________________________________________ Date:______________________ Your signature:_______________________________________________ REFERENCES – Not related to you (please list three): IMPORTANT! – Please contact your references and inform them that you are using them as references. Many people do not want to answer questions about others over the phone and refuse to provide a reference for that reason. Please provide a daytime and alternate phone number for your references. If we are unable to obtain references, we cannot process your application. I, _________________________________, hereby give ARMC permission to contact my references. PLEASE PRINT YOUR NAME Your Signature:_______________________________________ Date:______________________ Name: ________________________________________________ Years Acquainted:________________________ Phone(s): ______________________________________________ Relationship: ____________________________ Name: ________________________________________________ Years Acquainted:________________________ Phone(s): ______________________________________________ Relationship: ____________________________ Name: ________________________________________________ Years Acquainted:________________________ Phone(s): ______________________________________________ Relationship: ____________________________ Please sign below, attesting that all the information you have provided in this application is accurate and true to the best of your knowledge. Signature: ___________________________________________________ Date: ____________________ Physician Medical Certification Form-Confidential Medical Information: 
IMPORTANT: This form must be completed by your physician. If this form is not completed, your volunteer application will not be processed. Your Name:______________________________________________________________________________ Your Address:______________________________________________________________________________ Dear Physician: The individual noted above has applied for a volunteer position with AtlantiCare. Please complete the medical certification below: My signature below certifies that the individual noted above is free of communicable disease and is able to fulfill the requirements noted in the Volunteer Role Description. Physician’s Printed Name:___________________________________________________________________ Physician’s Address:________________________________________________________________________ Physician Signature:_________________________________________ Date:__________________________
____________________________________________________________________ ROLE DESCRIPTION
POSITION SUMMARY The Volunteer assists and supports hospital/hospice staff and management with patient care activities and administrative duties. Some hospital duties may include helping patients read letters, distributing reading material, transporting patients to and from therapy, and distributing gifts and flowers. Some hospice duties may include visiting patients to provide companionship, caregiver respite, or run errands for the families This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation. QUALIFICATIONS EDUCATION: Successful Completion of hospital orientation required. LICENSE/CERTIFICATION: Current driver’s license & auto insurance required for Hospice direct patient volunteers. For specialized volunteer services current licenses/certifications are required. EXPERIENCE: Prior experience with public contact required. PERFORMANCE EXPECTATIONS Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position. WORK ENVIRONMENT Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances, and potential injury. This position requires sitting, standing, walking, stooping and crouching a majority of the workday. Works with such equipment as computer terminal, fax machine, printer and copier. REPORTING RELATIONSHIP This position reports to the Volunteer Supervisor. The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position. (App updated 3-2015) Directory: images images -> Pelan pentaksiran kursus images -> Military callsign list as of dec 2010 images -> For Date: 02/01/2013 Friday Call Number Time Call Reason Action 13-768 0008 motor vehicle stop warning Issued images -> New embedded S images -> Creating Buy-In – Building Relationships images -> Deadline: Saturday, March 12th, 2016 images -> News items from Raising Our Voices images -> Last year four of the best Afrikaans Christian singers joined forces to tour Down Under with the production ‘Manne wat Glo’ images -> World-renowned vocal ensemble sweet honey in the rock images -> Peoples Voice Café History Download 0.5 Mb. Share with your friends:
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