Providence Alaska Volunteer Application

MAKE NOTE OF PASSWORD FOR FUTURE USE

________________________________________________________________________

LOCATION

Providence supports many of our Alaskan communities. Which location are you applying to volunteer in?

________________________________________________________________

PERSONAL INFORMATION

First name

Last name

Middle Initial

Preferred name

E-mail

Phone Number

Street Address

Apartment/Unit

City

State

Zip code

Date of Birth

Gender

________________________________________________________________

EMERGENCY CONTACT INFORMATION

Contact- First and Last Name

Phone Number

Relationship

________________________________________________________________

EMPLOYEMENT

Active Duty Military or Veteran

Current Providence Caregiver

________________________________________________________________

EDUCATION

Highest Level of Education

Are you volunteering as part of a requirement for school or ongoing education? If so, how many hours are you required to serve?

________________________________________________________________

REFERENCES

Reference 1- First and Last Name

Phone Number

Relationship

Email

Reference 2- First and Last Name

Phone Number

Relationship

Email

________________________________________________________________

ONBOARDING REQUIRMENTS

Providence volunteers are onboarded to the healthcare environment following the same criteria as paid caregivers which include:State and Federal ChecksState of Alaska Background Check (fingerprints may be required)Verification against State of Alaska and National Sex Offender databasesVerification against OIG- Office of Inspector General databaseVerification against SAM- System Award Management database Health Screening Verification of vaccination and immunization status for required MMR, Hep B, Varicella, TDAPDocumentation of COVID vaccination statusDocumentation of Flu vaccination statusQuantiFERON TB test (blood draw required) Online OrientationCompletion of online modules covering Providence mission, safety, infection prevention, code of conduct as well as integrity & compliance standards Are you able to participate with the above requirements?

________________________________________________________________

APPLICANT QUESTIONS

What brings you to volunteering at Providence and what would you like to gain from this experience?

Providence asks volunteers to commit to 100hrs of service (generally 2-4hrs per week). Are you aware of any reason that would prevent you from volunteering on an ongoing basis?

________________________________________________________________

Acknowledgement

I am applying to volunteer for Providence Health & Services- Alaska and confirm that the above information is true, complete, and provided freely.

I understand and agree that submitting this application does not automatically register me as a Providence volunteer and that placement is not guaranteed.

If I am offered a placement, I will be required to complete an on-boarding process that will include background check(s), health screening, and orientation.

I agree that if I become a volunteer, I will learn and comply with the regulations and requirements of the organization and uphold the commitment that I make.

I understand and agree that any falsification or omission of information herein, regardless of time of discovery, may result in my ineligibility to volunteer.

By checking 'I Agree', I indicate that I have read and agree to be bound by the above statements and conditions.

* I Agree

[ clear ]

Please sign your name in the box below