Midstate Adult Application
Qualified volunteer applicants are considered without regard to race, color, religion, sex, national origin, age,marital status, or the presence of non-job related medical condition or disability.
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Previous Volunteer Experience:
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Please provide two academic, professional, or volunteer references who are not related to you:
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Have you ever been convicted of or had a finding rendered by a court concerning a crime?
If yes, please specify: (Note: Conviction of a crime is not necessarily grounds for disqualification)
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I authorize the Volunteer Office to contact the references provided by me to obtain the information pertinent to my responsibilities as a volunteer at MIDSTATE Medical Center.
I agree to abide by the policies and regulations of MidState Medical Center and the Volunteer Services Department and to participate in orientation and training required by the Medical Center.
I will hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients orpersonnel and not seek to obtain confidential information from a patient.
I understand that I may be dismissed from my duties if I fail to comply with hospital policies and procedures, willful wrongdoing or negligence and/or performing duties outside of my service guidelines, inappropriate behavior, or anyother circumstances deemed contrary by the Manager of Volunteer Services to the best interests of the hospital.
I certify that the facts set forth in this application are true and complete to the best of my knowledge.I understand that if I am accepted into the Volunteer Services program, false statements may result in my dismissal.
I understand that I am expected to inform the Department of Volunteer Services of any significant change in my health status that would negatively impact on my ability to perform the tasks to which I am assigned.
* If you are a high school student completing the adult application, it will be rejected. Please wee our website for teen application information.