Advocate Christ Medical Center
Volunteer Profile

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Name

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Address

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City, State, Zip

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E-mail address

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Home phone

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Work phone

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Best Time to Contact You

Please indicate the reason you are seeking a volunteer position (check all that apply)

	Personal fulfillment		Professional Development
	Family/Friends involved with medical center		Extra Time
	Requirement for class/degree		Possible future career
	Other_________________________________

The following information is for statistical purposes and will not affect your volunteer placement.

I am 14 years old or older:  Yes    No

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Social Security Number

Gender				Student
	Male		Female		High School		College
					Service Hour Requirement
Education
	High School		Undergrad Degree		Graduate Degree		Trade School
Do you speak a second language?					Yes		No

If yes, language (s)____________________________________________________

Times You Are Available (Mon.-Sun., Morning, Afternoon, Eves.) Please mark the boxes to show your availability.

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Morning
Afternoon
Evening

How did you learn about volunteer opportunities at Christ Medical Center?

	Friend		Employer		Instructor		Co-worker
	Clergy		Doctor		Website		Newspaper
	Poster/Flyer		Other____________________________________________

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Please list your previous work experience.

Are there any areas in the medical center where you would not feel comfortable working?

Yes

No

If yes, what are they?

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Is there a particular type of volunteer work in which you are interested? (Check all that apply)

	Administrative/Clerical work		Hospitality/Information
	Indirect patient contact		Escorting/Transporting
	Special Services (mail, flower delivery, special projects)

Reference

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Name

___________________________________________________________________________
Address

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Phone

Emergency Contact (Must be listed)

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Name of person to contact in an emergency

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Phone number of this person

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Relationship to you

Please return this application via one of the following options:

Mail to:
Advocate Christ Medical Center
Volunteer Services
4440 West 95th Street
Oak Lawn, Illinois 60453

Fax to 708.684.4751

PLEASE READ AND SIGN AND BRING WITH YOU TO YOUR INTERVIEW.

The volunteer assumes the responsibility of projecting a manner that is pleasant and helpful to the patients, the medical center staff, the visitors, or with whomever they come in contact. As a representative of the medical center, a volunteer is expected to be loyal to the administration by being aware of and adhering to all Advocate Christ Medical Center policies.

Placement in an area depends both upon the current needs and the new volunteer’s desires and skills.

New volunteers are required to attend an orientation to learn medical center policies and procedures and correct ethics regarding patient interaction. Additional special orientations may be required to work in certain areas of the medical center.

It is required that all volunteers complete a health information form and take a PPD skin test for Tuberculosis prior to starting their volunteering.

It is required that all volunteers take an annual PPD skin test for Tuberculosis.

The volunteer assignment is to be considered the same as employment with respect to attendance, absence and tardiness, as well as all medical center and department polices and procedures.

The volunteer is expected to keep the commitment and inform the volunteer office and the department as far ahead as possible if they are unable to work.

The volunteer is responsible for maintaining the standard of work performance.

Volunteers must wear a designated uniform while serving as part of the Advocate Christ Medical Center team.

The volunteer must follow the appropriate dress code guidelines as discussed in the volunteer orientation.

ID tags must be worn at all times.

Smoking is not permitted anywhere on the medical center campus. Intoxicating beverages or illegal drugs should not be consumed prior to reporting on duty. Violation of any of these restrictions allows the strong possibility of immediate dismissal.

The volunteer is responsible for keeping all information confidential, including, but not limited to a patient’s physical condition, financial status, personal problems, associate information, and Advocate business plans or strategies.

Please read the following carefully and sign on the line provided.

I understand and fully acknowledge that in volunteering for Advocate Christ Medical Center, I am entering an AT WILL relationship and that this relationship can be terminated at any time by me or by Advocate Christ Medical Center. I also understand all of the above regulations and agree to follow the guidelines. It is my understanding that all information I provide to Advocate Christ Medical Center is true and complete to the best of my knowledge and I understand that I must provide information to Advocate Christ Medical Center regarding any medical problems and/or medications I am currently taking.

_____________________________________________________Date______________
Volunteer Signature