Ascension Florida Career Shadowing/Observation Experience Application

 

Please read the below information about our onboarding process and requirements before submitting your volunteer application

Thank you for your interest in volunteering at Ascension. It takes caring individuals like YOU to meet the growing healthcare needs of our community!

At Ascension volunteers are an essential part of our healthcare system. Their caring and generous spirits make a difference everyday – one person at a time.

Whether you are a retiree wanting to give back to the community, a student exploring health care careers, or you just have a desire to help others, each volunteer provides service that enhances our patient and family experience. Whatever the reason for volunteering, YOU can make a difference.

Due to the nature of our work, there are a number of requirements that all Ascension Volunteers must meet during our onboarding process. Please review the immunization and general requirements below before submitting your application. These requirements are provided to you free of charge. We will provide information on how to complete these requirements during your interview. 

Immunization Requirements

All Ascension volunteers must meet these immunization requirements:

  • MMR – Measles, Mumps, Rubella (either history of disease or proof of vaccination);
  • Varicella – Chicken Pox (either history of disease or proof of vaccination);
  • TB (tuberculosis) Testing - must be a TB blood draw QFT Gold or T-Spot within 90 days of application submission;
  • Flu vaccine is required annually before the beginning of the flu season (typically mid-November) for active volunteers and before or during flu season (mid-November to beginning of April) new volunteers;
  • TDAP within the last 10 years; and
  • Drug Screening.

Onboarding Requirements

All Ascension volunteers must meet these general requirements:

  • Complete Volunteer Application;
  • Meet volunteer immunization requirements (see above);
  • Consent to Criminal Background Check, social security number required;
  • Complete orientation and training; and
  • Ability to function independently with minimal supervision.

Not all shadow/observation roles are available for applicants under 18 years of age.

 

Site Preference
Contact Information
Name:
Address:
Please provide your home phone number, your cell phone number, or both.
Demographic Information
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.
International Applicants

All international applicants MUST complete the background forms instead of the eForms that are sent directly from Universal, Inc. 

All International Applicants MUST submit:  

  • The international address, and  
  • The US Address they currently reside in, and
  • A copy of their Visa/Passport.  
Education
Eligibility
Sponsor

Prior to beginning the Application process, the applicant must have a sponsor (associate or physician) that has already agreed to allow the applicant to shadow. Due to the large volume of requests, the Volunteer Office does not offer assistance in obtaining approval from a sponsor.

Please list the Sponsor Name, Specialty Area, and Contact information.  

Employment Information
Address
Experience Information
Specialized Training and/or Experience:
Availability Information
References
Reference 1 - Must Not Be Related To You
Reference 2 - Must Not Be Related To You
Reference 3 - Must Not Be Related To You
Emergency Information
Emergency Contact
Additional Information
Criminal Background History & Consent
Media Release

I agree and understand that:

  1. This consent relates to the use and disclosure of all information provided during my interview, all information recorded, and my name, image, likeness, appearance, voice, comments and quotations, biological information and other publicity rights (collectively, the “Results and Publicity Rights”).
  2. The Results and Publicity Rights may be used for any purpose, including, but not limited to, education, marketing, or public relations purposes. This includes and may be made public through education, marketing, and public relations efforts for commercial or non-commercial publications, exhibits, and/or on the internet and Ascension intranet.
  3. The Results and Publicity Rights may be used worldwide and in any media form, including, but not limited to, internet, newspaper, television, radio and/or marketing materials, in whole or in part, with such alterations and changes as Ascension desires, with or without my name.
  4. I will not have the opportunity to review or approve the Results and Publicity Rights prior to use and Ascension is not liable to me for any distortion or illusionary effect resulting from the publication of the Results and Publicity Rights.
  5. Ascension (or its agents) owns all Results and Publicity Rights, including any pictures, reproductions, negatives, and other recordings. Ascension is not required (obligated) to make use of any Results and Publicity Rights.
  6. I may revoke my permission to Ascension’s use of my publicity rights at any time. If I choose to revoke my permission, it will not affect Ascension’s prior use of the Results and Publicity Rights or continued use of the Publicity Rights for non-commercial purposes. I can revoke my permission by submitting a written request to Ascension Marketing & Communications, 4600 Edmundson Road, St. Louis, MO 63134.
  7. I release and discharge Ascension from any and all claims, actions, and demands arising out of or in
    connection with the use of the Results and Publicity Rights in accordance with this Consent.

Ascension Patients, Members, or Ascension Living Residents

You will be asked to sign another document, called a HIPAA Authorization, that allows Ascension to use and disclose your protected health information, or PHI. You are not required to sign this consent or an authorization to share your information as a condition of providing treatment, payment, enrollment in health plans, or eligibility for benefits on signing this consent.

Ascension Associates

You are not required to sign this consent. Your signing is voluntary and is not a requirement of your employment. You will not face any repercussions if you choose not to sign.

Affirmation Statement
Criminal Background History Consent & Statement

I hereby give my consent to conduct a criminal background history through the local county clerk of court records.  

I understand that this information will be used to determine my eligibility for job shadowing at Ascension.  

I waive and release Ascension and its agents from any and all claims I may otherwise have with respect to any such criminal background check.  

As a volunteer at Ascension, the undersigned will observe hospital operations and have access to what this agreement refers to as "Confidential Information."  

"Confidential Information" includes but is not limited to proprietary or non-public business information and patient information (including "protected health information" as defined by the Health Insurance Portability and Accountability Act of 1996). Confidential Information is valuable and sensitive and is protected by law and by Hospital policies. The intent of those laws and policies is to assure Confidential Information will remain confidential - that is, it will be used only as necessary to accomplish the Hospital's mission.  

Conversations between physicians, nurses and other healthcare professionals in the setting of a patient receiving care or between the undersigned and a patient are also protected and may not be discussed.  

The undersigned agrees not to disclose, copy, misuse or release any 'Confidential Information' that he/she may observe or have access to during the course of volunteering. The undersigned understands that the obligation under this agreement will continue after voluntary service is complete. The undersigned will be responsible for their conduct during the time spent volunteering in the hospital and understands that failure to comply with this agreement may result in personal civil and criminal legal liability. The undersigned understands that a breach of this Confidentiality and Non-Disclosure Agreement may result in civil lawsuits and administrative fines and sanctions.  

The undersigned agrees to indemnify, defend, and hold harmless the hospital, its affiliates, and all of its employees, against any claim or lawsuit that arises from breach of this agreement.  

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Ascension Volunteer Portal