Volunteer General | AdventHealth

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Volunteer

Where would you like to Volunteer*

Name*

First Name*

Initial (optional)

Last Name*

Birthdate *

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Month

Day

Year

Are you 16 or older?*

Yes No

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

High School Grade *

Provide only if you're currently in high school

Do you have volunteer experience?*

Yes No

If yes, where have you volunteered?*

List any special skills or hobbies*

Have you ever been a defendant in a civil action or intentional tort?*

Yes No

Have you ever pled nolo contendre (no contest) to any criminal offense (misdemeanor or felony) other than parking tickets?*

Yes No

What day of the week are you able to volunteer? Select all that apply.*

Sunday Monday Tuesday Wednesday Thursday Friday Saturday All - I'm flexible

What time of day are you available for a 4-hour time block/shift?*

Morning (8 AM - 12 PM) Early Afternoon (12 PM - 4 PM) Evenings (4 PM - 8 PM) Split Shift (10 AM - 2 PM) Other

Do you have any physical limitations?*

Yes No Prefer not to answer

Gender*

Female Male Prefer not to answer

Emergency Contact Information: Name, Relationship and Phone Number*

College Degree*

Or if you are in college

Please check which option applies to you:*

Adult Volunteer (ages 19+) Junior Volunteer (ages 14-18)

Phone*

Email*

Program of Interest*

Patient/Visitor Liaison-Entrances (Main Entrance, Women’s Pavilion, Patient Registration) – assists the concierge staff with welcoming patients/visitors and escorting patients/visitors to their destination. Inpatient Nursing Units – conducting patient comfort rounds for an excellent patient experience, assisting staff with keeping an organized and stocked unit. Outpatient Department– assists with administrative tasks including stocking, sanitizing equipment, telephone reception, assembling paperwork, etc.

Other: Other Value

How did you hear about our Volunteer Program?*

Have ever pleaded guilty to or been convicted of a felony offense or misdemeanor other than a parking ticket?*

Yes No

If yes, please explain:*

Disclaimer - Enter "I Agree" if you acknowledge the statement below. AdventHealth reserves the right to select only those volunteer applicants who successfully complete all requirements and pass all required backgrounds checks. This policy includes hospital staff applicants, agency, volunteers, traveler and contracted staff that seek to work at or for AdventHealth. I agree to perform my duties as a volunteer at AdventHealth in accordance with the rules and regulations supplied by AdventHealth Volunteer Services Department.*

Signature*

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Let's Keep in Touch

Yes, I want AdventHealth to send me information about its various services via phone, email or direct mail.

Campaign Source

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Campaign Medium

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Campaign Term

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Campaign Content

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Campaign Name

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GCLID (Google Click Identifier)

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Thank you for taking the first step to become a Volunteer at AdventHealth. You are a very important part of our Mission of Extending the Healing Ministry of Christ to this community. We are glad you are here.

The Second step consists of completing this application. Please read it carefully and fill out the required information. Once you submit this form, an AdventHealth specialist will reach out to discuss your interests and goals.

The Third step is completing the background check and the lab work at no cost to you. After the initial call, you will receive an email from Corporate Screening, a First Advantage Company with a link to begin the background check. This process can take between five and 10 business days. Once it is completed, an AdventHealth Specialist will contact you to schedule your visit with a Registered Nurse to do your lab work.

The Fourth and final step is to get you a badge and into the hospital for the Whole Care Experience in the New Employee/Volunteer Orientation.

I hope your journey as a volunteer brings you the meaning and joy you are looking for.

Cordially,

Volunteer Services

I want AdventHealth to send me information about the Volunteer Program via phone, text, or email. Data charges may apply. Check with your wireless provider.*

Yes No

Consumer Disclosure Document

By signing below, I authorize AdventHealth and/or its subsidiaries, parents, successors, and affiliates (the "Company") to order consumer reports from any consumer reporting agency ("CRA"), to the extent allowed by law. I understand that, to the extent allowed by law, the Company may rely on this authorization to order additional consumer reports from any CRA without asking me for my authorization again during any period of employment. For the specific purpose of preparing consumer reports for the Company, and subject to all laws protecting my privacy, I authorize the following to disclose to the CRA the information needed to compile the reports: law enforcement and all other federal, state, and local agencies; all courts; Social Security validation; licenses; credentials; my past or present employers; learning institutions, including colleges and universities; motor vehicle records agencies, if the job requires; and other background checks.

Select an option below*

In agreement with the Electronic Signatures in Global and National Commerce Act (E-Sign Act) of June 30, 2000, the applicant agrees that by signing the full name below, he/she has the intent to sign the e-form as part of the application for the volunteer services at the AdventHealth Central Texas or AdventHealth Rollins Brook I do not agree

Signature*

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Other State Law Notices *

In the following notices AdventHealth is referred to as "the Company" and Corporate Screening is referred to as "consumer reporting agency".
Contact details for Corporate Screening: 7271 Engle Rd, Ste 200, Cleveland, OH 44130, (800)
229-8606, www.corporatescreening.com.
New York residents and applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency directly. By signing the Acknowledgement and Authorization for Background Investigation, you acknowledge receipt of Article 23-A of the New York Correction Law.
New York City residents and applicants only: By signing the Acknowledgement and Authorization for Background Investigation, you further authorize the Company to provide you with a copy of your consumer report, the New York City Fair Chance Act Notice form, and any other docu-ments, to the extent required by law, at the mailing address and/or email address you provide to the Company.
Los Angeles residents and applicants only: For a copy of the Notice to Applicants & Employees Fair Chance Initiative for Hiring Ordinance go to https://bca.lacity.org/Uploads/fciho/Ban the Box
Poster-Private Employers%2C as of 8.23.18.pdf
San Francisco residents and applicants only: For a copy of the San Francisco Fair Chance Ordinance Notice go to https://sfgov.org/olse/sites/default/files/FCO poster2020.pdf
Washington State residents and applicants only: You have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
Erie County, PA residents and applicants only: The Company may order a criminal background check on you and any consideration of such a check will be tailored to the requirements of the job you have been conditionally offered.

Please check this box if you would like to receive a copy of a consumer report if one is obtained by the company.

Minnesota residents and applicants only: You have the right to submit a written request to the consumer reporting agency for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The consumer reporting agency must provide you with this disclosure within five business days after its receipt of your request or the report was requested by the Company, whichever date is later. Oklahoma residents and applicants only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the company.

Acknowledgement and Authorization for Background Investigation

I acknowledge receipt of the separate documents entitled CONSUMER REPORT DISCLOSURE DOCUMENT, A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and OTHER STATE LAW NOTICES and certify that I have read and understand those documents. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" by Advent-Health the "Company") at any time after receipt of this authorization and throughout my employ-ment, if applicable. To this end, I hereby authorize, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bu-reau, employer, or insurance company to furnish any and all background information requested by the Company subject to all laws protecting the individual's privacy, such as federal privacy laws related to educational records. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.

Date*

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Month

Day

Year

Select an option below *

Signature

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Consumer Authorization

Authorization: By signing below, you authorize: (a) The consumer reporting agency (CRA) to request information about you from any public or private information source; (b) anyone to provide information about you to the CRA; (c) CRA to provide us (AdventHealth) one or more reports based on that information; and (d) us to share those reports with others for legitimate business purposes related to your employment, internship or volunteering. The CRA may investigate your education, work history, professional licenses and credentials, references, address history, social Security number validity, right to work, criminal record, lawsuits, driving record, credit history, and any other information with public or private information sources. You acknowledge that a fax, im-age, or copy of this authorization is as valid as the original. You make this authorization valid as long as you are an applicant, employee, intern or volunteer with us.
The Consumer Financial Protection Bureau's "Summary of Your Rights under the Fair Credit Reporting Act" is attached to this authorization. If you are a New York applicant, a copy of New York's law on the use of criminal records is attached. By signing below, you acknowledge receipt of these documents.
Personal Information: Please print the information requested below to identify yourself for the CRA.

Name*

First Name*

Last Name*

Other Names Used*

Current Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Former Address 1*

Address Line 1

Address Line 2

City

State

ZIP Code

From Date*

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Month

Year

To Date *

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Month

Year

Former Address 2 *

Address Line 1

Address Line 2

City

State

ZIP Code

From Date *

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Month

Year

To Date *

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Month

Year

Some government agencies and other information sources require the following information when checking for records. The CRA will not use it for any other purpose. *

Date of Birth*

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Month

Day

Year

Report Copy

If you are applying for a job or live in California, Minnesota, or Oklahoma, you may request a copy of the report by checking this box

Select an option below *

Signature*

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