Dear Prospective Volunteer
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- Incomplete applications cannot be processed. AtlantiCare Volunteer Application – Confidentiality Statement
- AtlantiCare Physician Medical Certification Form-Confidential Medical Information
- ** PLEASE NOTE
- Please mail the completed Volunteer Application to
- At the completion of the Group Interview/Information Meeting, you will be asked to complete a C riminal Background Check/Authorization for Consent and Release from Liability Form.
- All applicants must pass the background check and be medically cleared to be considered for our volunteer team.
- Volunteer Services Department
- VOLUNTEER APPLICATION Instructions: Please complete ALL
Dear Prospective Volunteer: 
Thank you for your interest in volunteering with AtlantiCare. Volunteers are an important part of our team, providing support in the Medical Centers and satellite offices to help deliver exceptional services to the communities we serve. We are grateful that you will share your talents with us, and want your experience as a volunteer to be a rewarding one. Enclosed are the following documents which must be completed in full. Incomplete applications cannot be processed. AtlantiCare Volunteer Application – Confidentiality Statement – Please PRINT LEGIBLY the names and phone numbers of three references whom are not related to you. All references are contacted by phone and we ask that you alert your references about receiving a phone call on your behalf. AtlantiCare Physician Medical Certification Form-Confidential Medical Information. This form must be completed by your personal physician. ** If you don't have a personal physician, you are welcome to contact the AtlantiCare Access Center at 1-888-569-1000 for assistance. AtlantiCare does not cover any cost associated with the completion of the Physician Medical Certification Form. ** PLEASE NOTE –Immunity against the following diseases are required: measles, mumps, rubella, chicken pox, pertussis, influenza. If you have received vaccination for these diseases or have proof of immunity via bloodwork (titer), please obtain these records. You will need to take your records to Occupational Medicine for your scheduled appointment, explained below. If you do not have these proofs, we will provide the forms for you to be tested through AtlantiCare Occupational Health at no charge to you. Please mail the completed Volunteer Application to: AtlantiCare Hospice and Palliative Care ATTN: Maureen Hope P. O. Box 1626 Pleasantville, NJ 08232 OR you may fax to 609-407-2029, OR scan and e-mail to maureen.hope@atlanticare.org, OR place the application in an envelope marked to the attention of Maureen Hope and hand deliver to either the AtlantiCare Hospice and Palliative Care office, Airport Commerce Center, Suite 210, Egg Harbor Township, NJ 08234, or to the information desk at AtlantiCare Regional Medical Center Mainland Division, 65 W. Jimmie Leeds Road, Pomona, NJ
Upon receipt of your completed application, you will be sent by e-mail (or by USPS if you do not have e-mail), an invitation to attend a Group Interview and Information Meeting. At this meeting you will be photographed for ID, and receive the AtlantiCare Occupational Medicine Authorization for Services form to have the following tests performed, unless you have proof of the PPD testing and documentation of required vaccines, which you must bring with you to your scheduled appointment. These tests are of no cost to you: TB surveillance Measles, Mumps, Rubella screening if no documentation of 2 MMR vaccines or bloodwork titer Varicella screening if no documentation of 2 vaccines or bloodwork titer Drug screening These vaccinations are of no cost to you: T-dap vaccine Seasonal influenza vaccine **PLEASE NOTE - If the test results indicate you are not immune to Measles, Mumps, Rubella, or Varicella, the required vaccination(s) must be arranged by you through your personal physician. AtlantiCare does not pay for these immunizations. At the completion of the Group Interview/Information Meeting, you will be asked to complete a Criminal Background Check/Authorization for Consent and Release from Liability Form. Your social security number is required to run the background check, and if you are interested in being a hospice volunteer, you will need your driver’s license information. All applicants must pass the background check and be medically cleared to be considered for our volunteer team. When clearance is obtained, we will meet one-on-one at a mutually agreeable date/time to discuss the volunteer opportunities available and to plan your volunteering schedule. To remain active as a volunteer, the following are required: annual education, seasonal flu vaccine, and depending on the department in which you are volunteering, PPD testing may also be required. Please call if you have any questions. Thank you. Sincerely,  
Volunteer Services Department Phone: 609-407-2030 Phone: 609-407-2026 Fax: 609-407-2029 Maureen.hope@atlanticare.org kathleen.donadio@atlanticare.org Maureen Hope Kathleen Donadio
AtlantiCare is an Equal Opportunity Employer VOLUNTEER APPLICATION Instructions: Please complete ALL parts on this application. Incomplete applications cannot be processed. Please call the Volunteer Office at 609-407-2030 if you have any questions. Thank you. Date: _____________________________ Name: _____________________ ________________________ (First) (Last) Address:_________________________________________________________________________________ City:__________________________________ State:________________ Zip Code:___________________ Home Phone: __________________________Cell Phone:________________________________________ Business Phone: _______________________ E-mail Address: _____________________________________ 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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