AdventHealth Volunteer Application

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Auxiliary/Volunteer Application

Please select a location*

AdventHealth Dade City AdventHealth Zephyrhills AdventHealth Connerton

Name*

First Name*

Initial*

Last Name*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Date of Birth *

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Month

Day

Year

Gender*

Male Female

Phone*

Email*

High School Grade *

All interviews are conducted at the AdventHealth Zephyrhills Volunteer Office.

College Degree*

Previous Work Experience*

Volunteering Experience *

Special Training*

Skills and Hobbies*

Have you ever pled guilty to or been convicted of ANY CRIMINAL OFFENSE (misdemeanors or felony), other than parking tickets?*

Yes No

Conviction of a crime is not an automatic bar to consideration for volunteer

If yes, please explain*

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

Yes No

Have you ever been convicted of any criminal offense (misdemeanor or felony) other than parking tickets?*

Yes No

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

Yes No

If so, what is the nature of the intentional tort and disposition of the action?*

Will you work weekends?*

Yes No

Do you prefer mornings or afternoons?*

Mornings Afternoons Either

Do you prefer specific days?*

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Any

Do you have any physical limitations?*

If you have epilepsy, diabetes, allergy, heart condition, etc., and /or are taking special medication for any condition, it is important that you advise us so that in the event of an emergency resulting from your illness, medical personnel can provide proper treatment. This information will at all times remain confidential, except where it affects your ability to receive medical attention.

Emergency Contact*

Emergency Contact Relationship*

Emergency Contact Phone Number*

References

Please provide two references (i.e., Church member, school teacher, a neighbor — not a relative):

Personal Reference #1 - Name*

First Name*

Last Name*

Personal Reference #1 - Address

Address Line 1

Address Line 2

City

State

ZIP Code

Personal Reference #1 - Phone*

Personal Reference #2 - Name *

First Name*

Last Name*

Personal Reference #2 - Address

Address Line 1

Address Line 2

City

State

ZIP Code

Personal Reference #2 - Phone*

Signature*

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Use your mouse or finger to draw your signature above

Parent/Guardian Signature*

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Use your mouse or finger to draw your signature above

Disclaimer

AdventHealth Dade City/AdventHealth Zephyrhills reserves the right to select only those volunteer applicants who successfully complete all requirements and pass all required backgrounds checks.

AdventHealth Dade City/AdventHealth Zephyrhills does not employ those individuals who test positive for nicotine. This policy includes hospital staff applicants, agency, volunteers, traveler and contracted staff that seek to work at or for AdventHealth Dade City/AdventHealth Zephyrhills.

I agree to perform my duties as a volunteer at AdventHealth Dade City/AdventHealth Zephyrhills in accordance with the rules and regulations supplied by AdventHealth Dade City/AdventHealth Zephyrhills Volunteer Services Department.

Volunteer Applicant Information

Why do you want to volunteer?*

Teens: Where do you go to school? *

If this question does not apply to you, enter "N/A"

Are you in Florida year around?*

Yes No

How did you hear about our volunteer program? *

Have you volunteered before?*

Yes No

Where did you volunteer before? *

What did you enjoy most about your volunteer experience? *

What are your expectations for volunteering here (both from the volunteer services staff as well as the team members you may be working with during your assignment)?*

Have you had any experience in a hospital setting (either as a patient or in a work setting)?

Describe a specific occasion when you conformed to a policy even though you did not agree with it or adapted to changes in situations, directions, or people. What was the situation and what did you do? *

Describe a time when you were asked a question and you did not know the answer. What was your reaction? What did you say? *

Do you speak any other languages or have any special skills you would like to share?*

What other commitments do you have such as work, classes, etc.?*

On a scale of 1 to 10, describe your level of commitment to volunteering. Tell me why.*

In accordance with our guidelines, will you commit to volunteer a specific four-hour shift a week? *

Will you commit to volunteering for AdventHealth Dade City or AdventHealth Zephyrhills 100 or more hours before you stop volunteering?*

Yes No

Additional Comments

Volunteer Information

Process to Become an AdventHealth Volunteer

Volunteers are a vital part of AdventHealth Dade City/AdventHealth Zephyrhills. They bring a variety of experience and talents to the overall program and patient experience.  Our volunteers are valued. The process to become a volunteer is as follows:
1.	Obtain an application from the Volunteer Office, the main Information Desk or online at   www.AdventHealthDadeCity.com or  www.AdventHealthZephyrhills.com.
2.	Upon completing the application documents online, press submit and it will be received by the Volunteer Services Office.  You will then be called to set up an appointment for a phone interview.
3.	After satisfactorily completing the phone interview, a background check request will be submitted through Human Resources.
4.	After clearance from the background check, the Applicant will be scheduled for virtual orientation which will be sent to the applicant via e-mail.  Included will be orientation, a quiz and several documents to sign and submit back to the Volunteer Office.
5.	After successfully completing the virtual orientation, the Applicant will be scheduled for drug, nicotine, and tuberculosis (TB) screening.  These screenings will be scheduled with Employee Health by calling 813-783-6119 ext 1338.  There is no cost to the Applicant. You must bring a photo ID. Teens must be accompanied by a parent or guardian, who are also required to bring a photo ID. If a TB evaluation has been completed within a year's time, a copy may be presented to the Employee Health nurse.  Flu shots and TB Updates are required once a year.
6.	Upon clearance from Employee Health, the Applicant will be scheduled for a final appointment at AdventHealth Zephyrhills where they will receive a confirmation to their assignment, schedule, badge, shirt and start date.
Becoming a volunteer can take anywhere from 3 to 4 weeks depending on when the Applicant initially fills out the application. This process is necessary to ensure the hospital meets all the requirements and standards set by AdventHealth Dade City/AdventHealth Zephyrhills and other governing agencies.

Practices and Procedures

Volunteers are a vital part of AdventHealth Dade City/AdventHealth Zephyrhills.  Volunteers bring a variety of experiences and talents to our overall program and patient experience.  We truly appreciate your service!
***All onboarding appointments are conducted at the AdventHealth Zephyrhills Location.***
1.	AdventHealth Dade City/AdventHealth Zephyrhills does not employ those individuals who test positive for nicotine. This policy includes hospital staff applicants, agency, volunteers, traveler and contracted staff that seek to work at or for AdventHealth Dade City/AdventHealth Zephyrhills.
2.	The Volunteer Services Manager will interview applicants.  Job preferences will be considered; however, applicants may be placed according to hospital needs.
3.	Applicants must be at least 16 years of age and willing to commit to a minimum of one 4-hour shift each week and a minimum of 100 hours total within one year before resigning.
4.	An employee or volunteer in the assigned department will train new volunteers.  When in doubt, ask questions.  After two months, should the volunteer request a change in job, it can be addressed at that time.
5.	It is the responsibility of the volunteer to be on time to their assigned place of work and remain for the entire shift.  If unable to report for duty, please call your work area, not the Volunteer Services Office and let them know you will not be available that day.  Sign in and out every time you work.
6.	ALL volunteers must complete orientation & complete annual training once per year.  There may be other mandatory meetings scheduled that volunteers must attend (you will be notified).
7.	New volunteers are required to have a Drug, Nicotine, & TB Screening before beginning their work assignment.  This will be done at AdventHealth Zephyrhills at no cost to you.  You will call Employee Health after orientation to make an appointment.  All volunteers must fill out a TB update sheet on an annual basis.  Additionally, flu shots are required once per year.
8.	During the course of the day, you may overhear information regarding patients, hospital personnel or physicians, this is to be considered confidential.  Volunteers are not to discuss this information inside or outside the hospital.
9.	AdventHealth Dade City/AdventHealth Zephyrhills is a tobacco-free hospital.  The use of tobacco (including cigarettes, chewing tobacco, vaping, etc.) is prohibited on hospital grounds.  Do not come to work after consuming alcoholic beverages.
10.	Please notify your assigned department and the Volunteer Services office when you are going on vacation, going north, or taking a leave of absence (up to six months).  You cannot always be assured the same assignment upon return, although we will try to hold your position for you.
11.	Please notify the Volunteer Services office if you are terminating your service.  This will give others a chance to fill the position and the possibility to be trained before you leave.  Upon termination, please return your badge and shirt to the Volunteer Services Office.
12.	Volunteers are required to remain on hospital property during their shift assignment.
13.	Any in-service accident or incidents must be reported immediately to the Volunteer Services Office.  This office will file occurrence reports.
14.	Volunteers need to keep an accurate record of all hours volunteered.  Anything done for the hospital whether it is on hospital grounds or not, should be recorded.  These hours will be totaled on a monthly basis.  Hours must be kept up-to-date.
15.	If no hours are recorded and no communication with the volunteer office for 30 days, the volunteer will be removed from the active records permanently.
16.	Volunteers are requested to adhere to the dress code listed below and must be in uniform whenever on duty at the hospital.
o	Blue shirt with insignia (supplied by the Volunteer Office).
o	Black slacks or ladies may wear a black skirt that is to the knee or longer.
o	Shoes should be low-heeled with closed toes and closed heels.  Shoe color should complement your outfit.  Wear comfortable shoes.
o	White, black or navy long sleeve shirt under or sweater over your volunteer shirt; white long-sleeved shirt under your volunteer shirt when needed.
o	Jewelry, perfume, and after-shave should be kept to a minimum while on duty.
o	Name badges should be worn on the left collar of the volunteer shirt.
17.	Volunteers need to keep themselves updated on hospital events and any issues that will help them complete their responsibilities more efficiently.  Communication to the volunteers will be via email, telephone and/or notes. Please check your email and voice mail messages to keep up-to-date on what is available to you, as a volunteer.
18.	Observe all hospital rules and regulations.
19.	Do not witness any papers or legal documents in the hospital while you are on duty.
20.	Do not solicit or receive tips from patients or any other individuals.
21.	Have fun!  Volunteering is very rewarding and helps so many people.  Talk with the Volunteer Services Manager if you have any concerns.
VOLUNTEER BENEFITS
1)	Free Parking.  During the busy season, it is difficult to get a “good” parking space.  The community, patients and their visitors also feel that way.  Please park in the far parking lots (employee parking) during this time.
2)	Free Meal in the Café every 4-hour shift worked.  Please go through the cashier line, only one time per shift, so the Volunteer Services Department can be charged.  Please note that your allowance is $10.00.  Volunteers who spend more than $10.00 will be responsible for paying the additional cost.  Free fountain soda, iced tea or coffee “if” you bring your own cup.
3)	Annual Volunteer Recognition Banquet
4)	Participation in hospital functions

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