Hello! Thank you for applying for San Mateo Medical Center's Long-term volunteer program. Applying for the Long-term volunteer program does not guarantee your placement within the volunteer program. Applicants will be interviewed by the Volunteer Coordinator and Volunteer intern within seven days of filling out the application. Answer questions 18-21 with a minimum one-paragraph response.

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* 1. Are you 15 year or older?

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* 2. Full name

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* 3. Are you able to commit to volunteer a minimum of four hours a week for the next year?

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* 4. Address, City, State, Zipcode

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* 5. Phone number

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* 6. Birthdate

Date

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* 7. Email address

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* 8. Can we contact your current employer? (If you are not employed you can skip)

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* 9. List job duties and responsibilities

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* 10. What is the highest level of education you have completed?

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* 11. What are your hobbies, skills and special interests?

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* 12. Please give any other information you feel is pertinent to your application

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* 13. What days and times are you available to volunteer?

  Morning 7:00 am- 9:00 am Mid-morning 9:00 am-11:00 am Afternoon 1:30 pm- 3:30pm Evening 4:00 pm-6:00 pm Evening 6:00 pm -8:00 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 14. Have you volunteered in San Mateo Medical Center before? If yes in what year?

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* 15. Volunteer or work experience that may be helpful in placing you.

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* 16. Please explain briefly your reasons for volunteering

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* 17. Please indicate specific position(s) or area(s) of interest:

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* 18. Tell me about a time you made a error. What was the error? How did you fix it? What did you learn from it?

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* 19. How would you handle a situation where you witnessed another volunteer or staff member acting inappropriately?

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* 20. Can you tell us about a time you had to demonstrate empathy or compassion for someone?

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* 21. What is the most interesting place you’ve ever traveled to, and what did you learn from the experience?

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* 22. Personal and professional references (Please exclude family): List two references.

Examples: Teachers, Coaches, Tutors and employers

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* 23. Please be aware that a criminal record does not automatically disqualify you from volunteer work at SMMC. Have you ever been convicted of a crime? If yes, please describe the nature below.

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* 24. Have you ever been arrested for an offense for which you are currently out on bail or your own recognizance, pending trial? If yes, please describe the nature below.

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* 25. PLEASE READ THE FOLLOWING AND SIGN TO ACKNOWLEDGE YOUR AGREEMENT:

I hereby make application to the volunteer organization of San Mateo Medical Center (SMMC). I fully understand that any significant misstatement in or omission from this application will constitute cause for denial or revocation of my volunteer status. I hereby affirm that the information furnished by me is true and complete to the best of my knowledge and is furnished in good faith. I present this application in the expectation that the confidentiality and privacy of this information will be preserved.
Because I am donating my time, I understand that I am not an employee of SMMC and that I will not be paid for my work. I also understand that this organization is not obligated to provide a placement, nor am I obligated to accept the position offered.

I agree:
1. To perform my duties to the best of my ability.
2. To adhere to all medical center rules and procedures, including the policy of non-discrimination and harassment.
3. I will consider as confidential all information, which I may hear directly or indirectly concerning a patient, doctor, or any member of the medical center staff.
4. That all volunteer assignments can be terminated at any time, by either party, with or without notice and with or without cause. No volunteer assignment is guaranteed for any specific period of time.
5. To meet time and duty commitments, or to provide adequate notice so that alternate arrangements can be made.
6. That SMMC may check references, and/or do a background check which may include a fingerprint check and may use such information as may be obtained in making a decision regarding my placement.

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