THMA 2

Thank you for your interest in volunteering at Holy Cross Health. This application is assigned for high school students interested in volunteering and internships only. Only complete this form for the Holy Cross program. You must be at least 16 years of age on or before your first day of orientation to qualify.

Students should complete this application, not a parent. Please be sure to use a personal email address, as I cannot contact students through school email addresses.

Please complete each section as fully as possible.

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?
Checking Messages
Would you like to opt-in to text messaging?:
Contact flags
We communicate a lot by phone. This application should have the student's phone number, not a parent's phone number. Please check your voicemail frequently, and make sure it isn't full so we can leave a message. Please indicate you have read this message.
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.  

Skills and Experience
Assignment Preference
Before orientation week (first week after school ends), you will receive instructions on how to sign up for shifts that work into your personal schedule. You are responsible for making sure that you keep to your schedule.
School
Parent or Legal Guardian
Please list the name of the parent or legal guardian who is authorizing this high school student to serve at Holy Cross Health.
Health Care Provider (Doctor)
In the unlikely event we need to contact your doctor, please list their name and phone number here.
Essay
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. I am at least 16 years of age, which meets the minimum age to volunteer/intern, on or before the orientation date stated at the top of this application.
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