Thank you for your interest in serving our community by joining Providence Mission Hospital's Auxiliary. Please take a moment to complete the application below.

For more information about Providence Mission Hospital and our volunteer program, we encourage you to visit our website: Providence Mission Hospital.

Upon completion of this application, a representative from our membership team will reach out to you to schedule an interview. 

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* 1. Please provide your contact information below:

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* 2. Emergency Contact Information

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* 3. Please share with us how you heard about the opportunity to volunteer at Providence Mission Hospital. 

You may have heard of us from a former or current volunteer, employee, social media (Facebook/ LinkedIN/ Instagram), a flyer or message in your church bulletin, etc. 

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* 4. Please indicate if you were referred  to our volunteer program by a fellow volunteer or hospital employee. We would like to thank them.

  1. Name of the person who referred you.
  2. Indicate if they are a Volunteer or Employee

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* 5. What interested you in Providence Mission Hospital and joining our Auxiliary?

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* 6. Please choose the status that applies to you below:

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* 7. If you are student, please indicate where and what year.
If you are NOT a student, please continue to question #6.

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* 8. Are you currently employed?
If YES, please indicate the name of your current employer below.
If NO, please skip to Question #7.

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* 9. Have you ever been employed by Providence Mission Hospital?

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* 10. Please list any participation in other community organizations.

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* 11. In order to remain an active member of our Providence Mission Hospital Auxiliary, we require that our volunteers serve a minimum of 4 hours a week for at least 1 year. Please indicate below if you can commit to the minimum service.

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* 12. Please select the day(s) of the week you are available to serve.

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* 13. What time of day are you available to serve? Detailed time frames will be discussed during the interview process.

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* 14. Will you need an accommodation to perform specific duties related to volunteering? Please indicate YES or NO below. If yes, please also include details of the need.

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* 15. Please list any interests or skills below.

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* 16. Please list if you are interested in a specific department or service.

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* 17. Please provide 2 references (other than family).

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* 18. Have you ever been convicted of a felony?

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* 19. If you answered YES to question 16, please provide the details below (state, circumstance, place, date)

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* 20. I understand that my volunteer status is pending an interview and approval to proceed for a satisfactory health clearance; including a Quantiferon TB test, satisfactory proof of school identity, as well as training and provisional periods. I hereby authorize Mission Hospital to contact my references and to make any investigation of my background deemed necessary. 

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* 21. As a ministry of Providence, our VALUES are the guiding principles for all we do. Each of us is committed to these values and work to make them present in our relationships with each other and with those we are privileged to serve. Our values continue a tradition of excellence and a dedication to help heal all those we touch.

Compassion. Jesus taught and healed with compassion for all. –Matthew 4:24 

Dignity. All people have been created in the image of God. –Genesis 1:27 

Justice. Act with justice, love with kindness and walk humbly with your God. –Micah 6:8 

Excellence. Whatever you do, work at it with all your heart. –Colossians 3:23 

Integrity. Let us love not merely with words or speech but with actions in truth. –1 John 3:18 

I agree to conform to the rules and standards of Providence Mission Hospital and the Auxiliary. I have read the core values of the hospital, listed above, and agree to adopt these values in my contact with patients, staff, physicians and visitors in this facility.

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* 22. I certify that all answers or statements I have made on this application or other supplementary materials are true and correct without omissions. I acknowledge that any false statement or misrepresentation on this application or other supplemental materials will be cause for immediate dismissal as an applicant or during my association as a volunteer.

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