Beth Israel Deaconess Medical Center Volunteer Application

New User Details

User ID

User ID (verify)

Password

Password (verify)

Personal Information

* First (or preferred) Name

* Last Name

Preferred Pronouns:

* Profile photo

* Home Address

* City

* State

* Zip Code

* Cell Phone

Home Phone

* E-mail Address

* Date of Birth

* Government Issued ID (Can be a State ID, License or Passport etc. NOT a student ID)

If you are 18 years of age or older please select 'Adult'. If you are less than 18 years old please select 'Youth'. (Please note: people under 15 years old will not be selected to volunteer)

Emergency Information

* Name of Emergency Contact

* Relationship

* Emergency contact's e-mail

If you are under 18 y/o please add your parent/guardian's email address again. They will be cc'ed when we send certain communications to you.

* Emergency contact's phone

Volunteer Experience (most recent and if applicable)

Name of Volunteer Organization

Types of Duties Performed

Year(s) that you volunteered with this organization:

Employment Information (current or most recent employment and if applicable)

Current Employer

Current Position/Title

Education (If currently a student or most recent)

Current or most recent school or university

Graduation year or expected graduation year

Major, type of degree, or program of study (if applicable)

Highest level of education completed

Interests

* Why do you want to volunteer at Beth Israel Deaconess Medical Center? What kind of volunteer work are you looking to get involved in? Please note none of our volunteer positons are 'clinical'. Some offer patient interaction but volunteers cannot participate in clinical activities.

Is there anything else you would like us to know about your skills, experience, or preferences?

Availability & Commitment

How long would you be able to volunteer at BIDMC? Please note that there is a minimum number of hours and/or months associated with each position.For onsite roles, we prefer at least a 6 month commitment. Most roles have an expectation of once per week for 3-4 hours.

Please select days of the week and times of day that you would be available for a 3-4 hour shift. Select all that apply so that we may determine if there is role with an open shift that matches your availability.

Is there anything else you would like us to know about your availability? (Example: 'will be away during summer break.')

What languages do you speak?

References:
Please provide contact information for two references. References should not be members of your family, or close friends.

* Reference #1 Name:

* Reference email address:

* Reference phone number:

Reference #1 relationship to you:

Company, organization, or educational institution that reference is affiliated with (if applicable):

* Reference #2 name:

* Reference #2 email:

* Reference #2 phone:

Reference #2 relationship to you:

Company, organization, or educational institution that reference is affiliated with (if applicable):

A Quick Note Before You Submit Your Application

We're so glad you're interested in volunteering with us! To help keep our community safe and supportive for everyone, there are just a couple of important things to know before you complete your application:

To ensure patient safety, BIDMC requires all in-person volunteers and staff to complete the health clearance process. This includes undergoing a TB test, as well as being vaccinated for Hepatitus B, MMR, chickenpox, tetanus, COVID-19, and receiving an annual flu shot (unless you have a medical exemption). By selecting 'Yes,' you agree to comply with this these requirements.

All applicants aged 18 and older are required to undergo a background check. As part of this process, you will be asked to provide your Social Security Number. By selecting 'Yes' below, you are giving your consent for this background check to be conducted.

To the best of your knowledge, are you eligible to work within all federal health care programs, state health care programs, and federal procurement or non-procurement programs?

Have you been excluded, suspended, debarred, or otherwise ineligible from working within any federal health care programs, state health care programs, or within federal procurement or non-procurement programs?

PLEASE READ CAREFULLY AND CHECK "I AGREE" BELOW

I certify that the information given above is true and complete and I understand that misrepresentation and/or withholding of information will result in the rejection of this application or my discharge if discovered after volunteer service begins. I authorize the Medical Center to make inquiries regarding my history and character of prior employers, schools, etc. and hereby release employers, schools or individuals from all liability in responding to inquiries in connection with my application and release the Medical Center from all liability with respect to such inquiries.

I understand that if I am a volunteer, I will be a volunteer "at will" and may terminate my volunteer assignment at any time with or without cause or notice and that the Medical Center also has that right. I also understand no representative of the Medical Center, other than the President, has any authority to enter into any agreement for volunteer service for any specified period of time or to make any agreement contrary to the foregoing and that such agreement must be in writing. As a volunteer, I agree to abide by the Medical Center's policies, rules and procedures and any changes thereto.

I understand that I must provide the Medical Center with updated immunization records that include verification of a Tuberculosis test within the past year. If under 18 years of age, please use the enclosed parental consent form.

* I agree