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Patient Care Volunteer Program Application Form

Thank you for your interest in exploring volunteer opportunities at Children's National Medical Center, an Equal Opportunity Employer. We welcome your interest to apply for the Patient Care Volunteer Program.

Submission of this application is the beginning of the application process to join the Patient Care Volunteer Program. Applicants are subject to a complete background investigation performed by an outside agency and must submit a comprehensive medical form and two professional references; further information and appropriate materials will be given at the orientation sessions.

Please note: Due to the volume of applications we receive, and the specific requirements of the program we offer, we are unable to place every applicant. The Volunteer Services Department reserves the right to amend the scope and/or specifications of its program at any time.

ALL APPLICANTS MUST REVIEW VOLUNTEER DESCRIPTION AND SPECIFIC PROGRAM REQUIREMENTS NOTED ON WEBSITE PRIOR TO COMPLETING APPLICATION.

Please contact the Volunteer Services Office with questions regarding the program or the application form.

Mandatory Orientation
All applicants are required to attend a mandatory orientation session. During these orientations, staff will give an overview of the Patient Care Volunteer Program as well as explain the volunteer application process. All potential volunteers are required to attend one orientation session in its entirety if interested in pursuing the opportunity as a Patient Care Volunteer at Children's National Medical Center. The Orientation sessions begin promptly at the scheduled time and typically run one hour in duration. Additional time is allotted for a question and answer session.

Orientation Dates for Spring 2013 Patient Care Program:
Orientation has been completed at this time. Please check back after June 30, 2013 for more information

Please indicate which orientation you will attend:

Volunteer Information
First name: *
Last name: *
Middle name:
Title:
Nickname:
Street 1: *
Street 2:
Street 3:
City: *
State: * Zip:  *
Home phone: OK to call me here
Work phone: OK to call me here
Cell phone: OK to call me here
Email address:
Date of birth: * (year optional)
Languages Spoken:

Education and Experience
Education:
Employer:
Position:
Previous Employer:
College:
High School:
Organizations/Clubs:

Availability
Please indicate the days and times you are usually available to volunteer.

  Sun Mon Tue Wed Thu Fri Sat  
Morning:  
Afternoon:  
Evening:  
Weekend:  

My availability is: *
I would like to serve up to:
hours: *

Emergency Contact
First name: *  
Last name: *  
Home phone:  
Work phone:  
Cell phone:  
Relationship: *  

Applicant Question: Interest in Program
We are very interested in how you found the Patient Care Volunteer Program. Please indicate why you are interested in participating in the Patient Care Volunteer Program and how you found our program.

Why are you interested in volunteering at Children's National?

Applicant Question: Interest in Volunteering
What would you like to do most as a volunteer?

Applicant Question: Experience with Children
Patient Care Volunteers work directly with children. Please describe your experience working with children, including your own.

Volunteer Skills
Please provide us with additional information about special skills you may have. Please include information that was not covered in this application which is relevant to your acceptance into the Patient Care Volunteer Program.



Optional Information: Demographics
The below section is optional. Volunteer Services at times is asked for periodic reports pertaining to factors such as race, sex, and citizenship. Information provided will be used solely for statistical purposes and to track diversity trends. This information will not have any effect on the selection process. Children's National does not discriminate against its employees or volunteers or applicants for employment or service because of race, color, sex, religion, national origin, disability, veteran status, age, marital status or any other protected group status.

Gender:
Ethnicity:
US Citizen:


Volunteer Training Schedule
Prospective volunteers who are SELECTED to participate in our Patient Care Volunteer Training Program must attend both training sessions in their entirety.
• Saturday, May 4, 2013 10am - 5pm
• Sunday, May 5, 2013 1- 6pm

Criminal Background
Have you been convicted of any offense other than a traffic violation? Please indicate yes or no.

If yes, please explain.

Volunteer and Program Commitment Agreement
I understand volunteers must be at least 18 years of age, agree to serve a regular placement of at least 100 service hours in a calendar year and submit a heath form, references and fulfill other requirements as prescribed at Orientation before beginning volunteer service. I also authorize for release of general information given on this application.

I verify that I read the program description, requirements, and physical demands of the Patient Care Volunteer Program and understand the role of a volunteer at Children's National.

I understand completing this application is the first step of the comprehensive acceptance process to join the Patient Care Volunteer Program. If I am interested in proceeding in the process, I will follow the appropriate steps as outlined by Volunteer Services.

I understand that I will be asked to present written, valid, official government documentation that I am legally present in the United States for the duration of the time that I will be volunteering at Children's National (i.e. VISA, passport, or Social Security Card). I will present my government-issued photo ID at the time of my interview.

If accepted into the program I agree that I will attend all scheduled training sessions in their entirety.
 I Agree
 


   
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