THMA 2
Thank you for your interest in serving at Trinity Health Mid Atlantic. Please complete the following application for Volunteer Services to consider.

Please complete each section as fully as possible. Please create a password to manage your personnel account. This section is not asking for your email address's account password.

The last 4 digits of your Social Security Number (SSN) are required for volunteering/interning by Trinity Health. All adults must undergo a background check and be entered into our system as a service provider. To accomplish both of these tasks, all volunteers/interns must have a valid SSN. This information will be securely maintained on our servers only.

Requested Site
Personal Information
Would you like to provide your cell phone number and/or home phone number?
Demographics
The following information is used only to help us get a better idea of the demographic make-up of our volunteers.
Health Screening
In the checkbox below, please indicate that you understand all accepted applicants will need to be cleared for Tuberculosis (Tb) exposure by our Colleague Health Department before you may begin volunteering, and annually thereafter.

 

Influenza vaccination is required when volunteering between September 1 and June 30.

These vaccinations and health clearance are required, in addition to MMR and Varicella.  

Assignment Preference
Although your availability may change, we want to know how long you would like to volunteer with us (weeks? months? years?)Please consider the following choices as a guideline. Only choose positions listed in the location of your choice (Germantown, Silver Spring, or non-hospital). If you do not see exactly what you are looking for, choose something similar. Refer to our Volunteering Opportunities page for a description of the categories. Final assignments will be decided after a successful interview.
Availability
Please indicate the days and times you are usually available to volunteer. We understand your availability may change but your current availability can help us find a suitable placement for you.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
My availability is
Background History
Holy Cross Health does not allow any volunteering to fulfill court-mandated hours. By checking off the "Background check" box you agree that, if accepted, you complete a background check. This background check will be completed free of charge to the volunteer prospect.
Emergency Contact
In the event of an emergency, we need the name and phone number of a friend or family member. Please list them here.
Health Care Provider (Doctor)
In the unlikely event we need to contact your doctor, please list their name and phone number here.
References
References should be non-family member references, professional or educational, for people who know you well and can speak to your abilities. Please list 2 references here. Include full name, email address, and best phone number. Upon interviewing, you may be asked to provide a letter of reference from each.
Reference #1
Reference #2
Volunteer Agreement

If I am accepted as a volunteer, I agree to:

  1. Keep all information regarding patients/clients confidential.
  2. Give permission for the Volunteer Services staff to discuss my work history and performance with those I have listed as supervisors and references and with my potential HCH supervisor(s).
  3. Sign in and out each day I volunteer according to the protocol set up for my particulars area.
  4. Volunteer a minimum of 100 hours unless otherwise stated by a partnering organization. I understand verbal/written verification of hours or letter of reference/recommendation will only be given after I have contributed the minimum number hours.
  5. Be punctual and regular in attendance.
  6. Notify my supervisor(s) in advance if I cannot work my schedule.
  7. Wear the hospital I.D. badge while on volunteer duty.
  8. Purchase my own volunteer jacket (new -$30, used-$20) and wear it whenever on duty. (Hospice, Sterile Processing and some other volunteers are not required to wear jackets.) 
  9. Not expect compensation or employment as a result of my volunteer work.
  10. Provide my own transportation to and from the volunteer work site at my expense.
  11. Notify my supervisor(s) and the Manager of Volunteer Services of my intention to resign from volunteering at least two weeks prior to my last day of service. 
  12. At the end of my last day, return to Volunteer Services the hospital I.D. badge.
  13. Abide by Holy Cross Hospital policies and procedures.
  14. To have a background check (for 18 years and older).
  15. To obtain a flu vaccine every year.

I certify that:

  1. I am at least 18 years old.
  2. I am not volunteering as a court requirement or as an attorney referral.
  3. I have never been convicted of a crime.
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