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    Volunteer Services
    Sutter Roseville Medical Center

    Please complete this application if you are interested in a volunteer placement at Sutter Roseville Medical Center (SRMC). Note: you must be able to make at least a one year commitment.
       
    Profile  
       
    Email
    We do not share your email with anyone else; however, it is the primary way we inform you of what’s going on.
       
    Experience  
    Yes       No
    Yes       No

       

       

    Have you had volunteer experience: Yes       No

       
    Please provide the names of any SRMC Auxiliary members and/or names of individuals, who would be willing to give a character reference for you.

    Yes No

    Yes No
       
    Availability and Interest

       
    Sunday Monday Tuesday Wednesday Thursday Friday Saturday
    Morning Morning Morning Morning> Morning Morning Morning
    Afternoon Afternoon Afternoon Afternoon Afternoon Afternoon Afternoon
    Evening Evening Evening Evening Evening Evening Evening
       
    Admitting/Information Desk Emergency Department Cancer Registry Charts
    Fund Raising Sales Comprehensive Cancer Center Clinic Gift Shop Inpatient Surgery Recovery
    Labor and Delivery Navigator NICU Nursery/Postpartum
    Outpatient Recovery Pediatrics Physical Rehabilitation STARS
    Surgery Information      
       
    Yes       No

       

       

       

       

       

       
    Yes       No

       
    APPLICATIONS FOR JUNIOR VOLUNTEERS ARE ONLY ACCEPTED IN APRIL OF EACH YEAR
    Sr Auxiliary Applications      Jr Auxiliary Applications      Student Nurse Volunteer
     

    Confidentiality
    Please read and initial at the bottom indicating that you have read and understand the confidentiality requirements at SRMC.

    I understand and agree that in the performance of my duties as a volunteer at SRMC, I must hold patient information in confidence. Hospital volunteers have an ethical responsibility to protect patient privacy. Information regarding patients must not be released, disclosed, or discussed either inside or outside the hospital.

    There are laws, both state and federal, safeguarding patient records and penalties for the release of confidential information without patient authorization. I understand all may result in action including possible termination, fine, or imprisonment.

    As a volunteer, I will consider all confidential information that I hear about patients, families, and hospital personnel as private.

    I agree

       

    Background Check and Personal Statement
    I certify that the information provided in this application is true and complete. I understand any false information, misrepresentation, or concealment of fact is sufficient grounds for immediate discharge by SRMC.

    I understand and agree that all information furnished in this application may be verified by SRMC. I hereby authorize all individuals and organizations named or referred to in this application, and any records repository, or law enforcement organization, to give SRMC all information relative to my employment, work habits, character, credit history, and any criminal records. I hereby release such individuals, organizations, and SRMC from any and all liability for issuing, receiving, and using any such information. I agree that, if accepted, I will abide by the philosophy and all policies and procedures established by SRMC. I further understand that either the hospital or I can terminate my role as a volunteer at any time for any reason.

    I agree

       

    Placement
    Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, or sex.

    The volunteer service is not obligated to provide a placement, nor are you obligated to accept the position offered.

    I agree