Volunteer Services Application

Thank you for considering volunteering with North Valley Hospital.

North Valley Hospital’s (NVH) goal is to provide a safe and healing environment for its patients, visitors, volunteers and employees. NVH follows a safe hiring program that includes conducting thorough background checks, employment and education verifications, and a health screening.

By signing the NVH Volunteer Services Application, applicants certify they have provided true and correct information, and they understand that misstatements or omission of material facts in the application or the orientation process may result in discontinuing of the volunteer orientation process or termination of involvement in the volunteer program, no matter when discovered. Additionally, applicants consent to background checks and a health screening to verify immunizations. Although immunization records are not expected to be submitted with the initial application, applicants will need to provide documentation during the application process. Applicants also consent to verification of educational and professional credentials, as well as current and past employment.

Application Process
For consideration of all volunteer opportunities, applicants are asked to thoroughly complete the NVH Volunteer Services Application. You may also contact the volunteer coordinator to receive an application by email or standard mail.

If you need assistance in completing this application, please call Volunteer Services at (406) 863-3585.


Personal Information


First Name *

Middle Initial

Last Name *

Address *

City *

State *


Zip *

Home Phone *

Cell Phone

Work Phone

May we contact you at work?
Yes   No  

Email Address

Emergency Contact *

Emergency Contact's Phone Number *


Volunteer Area of Interest and Availability


Please consider me for the following volunteer areas:
Greeting and helping visitors/families (hospital host)    Mailings/special projects    Special events    Dog visitation program    Bake sales    Library    Baking cookies    Campus and fit trail litter patrol    Recycling program    Office/clerical    Aromatherapy    Hospital historian    Other:    Gift Shop   



What date are you available to begin volunteering? *

Maximum hours per week you would like to volunteer? *

Schedule/Shift(s) Preferred *
Morning    Afternoon    Evening    No preference    Two-hour shifts    Four-hour shifts    Other:   



Day(s) Available to Volunteer *
Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday   


Skills and Training Experience
Please rate your level of experience for each of the following skills.


Office/Clerical
10-key calculator *
Little or no experience or training   Some experience or training   Extensive experience or training  

Cashier *
Little or no experience or training   Some experience or training   Extensive experience or training  

Data entry *
Little or no experience or training   Some experience or training   Extensive experience or training  

Filing - alphanumeric *
Little or no experience or training   Some experience or training   Extensive experience or training  

Filing - medical terminal digit *
Little or no experience or training   Some experience or training   Extensive experience or training  

Inventory *
Little or no experience or training   Some experience or training   Extensive experience or training  

Medical terminology *
Little or no experience or training   Some experience or training   Extensive experience or training  

Multiline phones *
Little or no experience or training   Some experience or training   Extensive experience or training  

Photocopying *
Little or no experience or training   Some experience or training   Extensive experience or training  

Receptionist *
Little or no experience or training   Some experience or training   Extensive experience or training  

Scanning/archiving *
Little or no experience or training   Some experience or training   Extensive experience or training  

Typing/keyboarding *
Little or no experience or training   Some experience or training   Extensive experience or training  

Switchboard/PBX *
Little or no experience or training   Some experience or training   Extensive experience or training  

General
Cooking/baking *
Little or no experience or training   Some experience or training   Extensive experience or training  

Customer service *
Little or no experience or training   Some experience or training   Extensive experience or training  

Food preparation *
Little or no experience or training   Some experience or training   Extensive experience or training  

Barista (making coffees) *
Little or no experience or training   Some experience or training   Extensive experience or training  

Maintenance *
Little or no experience or training   Some experience or training   Extensive experience or training  

Shipping/receiving *
Little or no experience or training   Some experience or training   Extensive experience or training  

Small power tools *
Little or no experience or training   Some experience or training   Extensive experience or training  

Gardening *
Little or no experience or training   Some experience or training   Extensive experience or training  

Computer Software
MS Excel *
Little or no experience or training   Some experience or training   Extensive experience or training  

MS Outlook *
Little or no experience or training   Some experience or training   Extensive experience or training  

MS PowerPoint *
Little or no experience or training   Some experience or training   Extensive experience or training  

MS Publisher *
Little or no experience or training   Some experience or training   Extensive experience or training  

MS Word *
Little or no experience or training   Some experience or training   Extensive experience or training  

Other Skills


Applicant Statement

Authorization and release: I authorize the investigation of all matters that NVH deems relevant to my application to volunteer, including all statements made in this application, all attachments or supporting documents, and all interviews. I authorize NVH to request and receive all information it considers relevant, including current and former employments, education, and training. I release from all claims, liability, and damages all persons (such as current and former employers, supervisors, or coworkers) supplying information to NVH. I also release NVH, including its officers, employees and agents, from all claims, liability, and damages that arise from conducting any investigation.
Verification: I certify that the facts and information contained in this application are true and correct, including all attachments, supporting documents, and the contents of all interviews. I understand that any falsification, misrepresentation, misleading statement, or omission during the application process will result in denial of volunteer opportunities or, if discovered after starting a volunteer role, will constitute good reason for NVH to immediately terminate volunteer opportunity, regardless of when or how discovered.
Volunteer contingencies: I understand that volunteering is contingent upon satisfactory references, outcome of a criminal background check and any other conditions that may be required by any government agency or NVH. I will undergo initial TB skin testing, flu vaccinations, and/ or any additional tests or titers recommended by the NVH employee health nurse to determine proof of immunity as a condition of volunteering. I understand that NVH can terminate my volunteerism at any time during the Introductory Period, with or without cause and without advance notice.
Signature: By signing this Statement, I assure NVH that all verbal and written statements provided are true and accurate, and I agree to the conditions set forth in this Applicant Statement.


Signature (by entering your full name below, you agree with the Applicant Statement) *

Today's Date *


This section to be completed only if applicant is under the age of 18.

Consent of Parent or Guardian

Volunteer requirements:

Both my daughter/son and I understand the responsibilities and requirements of being a volunteer at North Valley Hospital.


I hereby give my consent for my daughter/son (enter name below) to serve as a volunteer at North Valley Hospital

Parent/Guardian Signature (by entering your full name below, you give your consent)


References
References can be employers, co-workers, or people with whom you interact outside the home or workplace.

For each reference, please include:



Reference 1

Reference 2

Reference 3