Volunteer Application

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Name * Required
First Last
Type of application: * Required
- Adult (18+)
- Teen
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email * Required
Phone * Required
High School * Required
Graduate Year * Required
College
Degree
Graduate Year
Current Employer
Shift Hours
Position
I'm interested in volunteering: * Required
- Errands
- Gift Shop
- Peeples Cancer Institute
- Anna Shaw Children's Institute**
- Pet Therapy
- Hospice
- Cuddler** (must be 25 years old)
- CPE (Clinical Pastoral Education) For more information contact Chaplain Ken Waddell 706-272-6000 ext. #2015)
**All cuddler volunteers must have the pertussis vaccine.
EMERGENCY CONTACT * Required
First Last
Phone * Required
Alternate Phone
Relationship
Name of Physician
Physician Phone
Languages Spoken * Required
- English
- Spanish
- German
- French
- Tagalog
- Other*
*Other language(s) spoken
Have you volunteered at Vitruvian in the past?
- Yes
- No
When?
Other volunteer experience:
What are your hobbies, skills, & talents?
Best way to contact you? * Required
- Phone
- Email
It is policy of Hamilton Health Care System (HHCS), as a condition of volunteering that all Volunteers shall be immune to influenza. If you are unable to receive the flu vaccine you will need to fill out the vaccine exemption request form seasonal influenza. If the exemption is approved you must wear a mask and alternate badge ID while in the hospital during flu season November 1st through March 31st. Volunteers of HHCS are subject to random drug screening. Non-Family References (please give complete information)
Non-Family Reference #1
First Last
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Non-Family Reference #2
First Last
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Several positions require moderate physical strength and/or excessive walking. Do you have physical limitations or are you under treatment that may limit your ability to perform in a voluntary capacity? _____Yes / _____No Hamilton Medical Center request a minimum one (1) - year commitment with an agreement to serve a minimum of three (3) hours per week. THE ABOVE INFORMATION IS CORRECT AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT VOLUNTEERS ARE NOT COMPENSATED FOR THEIR TIME OR SERVICE DONATED, AND THAT VOLUNTEERING DOES NOT GUARANTEE EMPLOYMENT AT HAMILTON. Hamilton Health Care System (HHCS) requirement is all Volunteers be immunized to influenza. If you are unable to receive the influenza (flu) vaccine you will need to complete Hamilton’s vaccine exemption request form each year you volunteer. If the exemption is approved, you must wear a mask and alternate badge ID while in the hospital during flu season November 1 through March 31. Hamilton Health Care Systems (HHCS), requirement is all Volunteers be immunized to Covid 19. If you are unable to receive the Covid 19 vaccine, you will need to complete Hamilton’s Covid 19 vaccine exemption request form. If the exemption is approved you must wear an N-95 mask, face shield and alternate badge ID while in the hospital. Volunteers of HHCS are subject to random drug screening. By signing my signature / electronic I understand and agree if I discontinue my volunteer service at Hamilton, I am required to turn in my badge to my supervisor immediately. I give my consent for pre-placement testing, which may include chest x-ray, urine drug screen, TB screening, blood testing and /or other testing as deemed necessary. I also give my permission to Hamilton Health Care System to administer any first aid and/or medical treatment deemed necessary in the case of injury or illness suffered during the course and scope of service.
SUNDAY
- 8:30 a - 11:30 a
- 11:30 a - 2:30 p
- 2:30 p - 5:30 p
MONDAY
- 8:30AM - 11:30AM
- 11:30AM - 2:30PM
- 2:30PM - 5:30PM
- 5:30PM - 8:00PM
TUESDAY
- 8:30AM - 11:30AM
- 11:30AM - 2:30PM
- 2:30PM - 5:30PM
- 5:30PM - 8:00PM
WEDNESDAY
- 8:30AM - 11:30AM
- 11:30AM - 2:30PM
- 2:30PM - 5:30PM
- 5:30PM - 8:00PM
THURSDAY
- 8:30AM - 11:30AM
- 11:30AM - 2:30PM
- 2:30PM - 5:30PM
- 5:30PM - 8:00PM
FRIDAY
- 8:30AM - 11:30AM
- 11:30AM - 2:30PM
- 2:30PM - 5:30PM
- 5:30PM - 8:00PM
SATURDAY
- 9:00AM - 12:00PM
- 12:00PM - 3:00PM
- 3:00PM - 6:00PM
9:00am-12:00pm
Anna Shaw Children's Institute
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
1:00pm-4:00pm
Anna Shaw Children's Institute
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Several positions require moderate physical strength and/or excessive walking. Do you have physical limitations or are you under treatment that may limit your ability to perform in a voluntary capacity? * Required
- Yes
- No
THE ABOVE INFORMATION IS CORRECT AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT VOLUNTEER POSITIONS ARE NOT COMPENSATED FOR THE TIME OR SERVICE DONATED. * Required
- True
- False
Name
This field is for validation purposes and should be left unchanged.

HAMILTON MEDICAL CENTER IS NOT OBLIGATED TO PROVIDE A PLACEMENT, NOR ARE YOU OBLIGATED TO ACCEPT THE POSITION OFFERED. OPPORTUNITIES ARE PROVIDED TO APPLICANTS WITHOUT REGARD TO RACE, RELIGION, CREED, NATIONAL ORIGIN, AGE OR SEX

Revised 1/18/17

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