Ascension Florida Adult Volunteer Application

This application is for adults ages 18 years and over.

 

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;
  • Commit to 4 hours of service each week for a minimum of 6 months;
  • Complete orientation and training; and
  • Ability to function independently with minimal supervision.
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.
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
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.

Terms and Conditions
Please Read Carefully

 

I hereby certify that all the facts and information listed on this application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application after I am accepted as a volunteer may result in my dismissal. I hereby authorize the Medical Center to investigate all statements contained in this application, to interview the references listed on this application. I authorize the references listed to give the Medical Center all facts, opinions and any other information they may have, personal or otherwise, and release all such parties om any liability which may allegedly arise from furnishing such information to the Medical Center, included but not limited to, any liability for defamation or invasion of privacy. I hereby authorize the Medical Center to perform a background check as necessary. I certify that I have read, understand and agree with the above.

I understand that my submission of this application does not guarantee my placement as an Ascension volunteer. All volunteer applicants are subject to screening which includes application verification, personal interview, criminal background and reference checks.  

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Ascension Volunteer Portal