Beth Israel Deaconess-Plymouth

Adult Application

Thank you for your interest in volunteering at Beth Israel Deaconess Hospital Plymouth. A variety of positions are available, from escorting our patients to visiting our patients, helping in the Emergency Department, Endoscopy, Surgical Services, Oncology, the Gift Shop and more. You will find your gift of time will be greatly appreciated by BID Plymouth patients and staff. There is a great sense of community & connection within our doors!

* First name

Middle name

* Last name

* Street Address:

Mailing Address if Different from Street Address:

* City

State

* Zip

* Phone

* E-mail

* Date of Birth

Have you ever been a volunteer before?

If Yes: where?

How did you hear about us?

If Other: Where?

If you work or have worked in the past please list the type of work you do/did:

What day/s would work best with your schedule?

What time of the day would fit your schedule?

Shirt Size for Uniform

Volunteer Preference

Work directly with the public/people:

*All Pet Therapy Applicants must provide a recent physical and vaccination record along with your Pet Therapy Certification.

References

We request that you provide us with three (3) references who can be either a friend (over 22 years of age), former employer, teacher, etc. (not a relative). Please include their name, relationship,telephone number and e-mail address so that we may contact them.

* Name

* Relationship

* Telephone #

* Email address

* Name

* Relationship

* Telephone #

* Email Address

* Name

* Relationship

* Telephone #

* Email Address

I give permission for Beth Israel Deaconess Hospital-Plymouth Volunteer Services to contact and obtain a personal reference from the people I have listed above.

Volunteer Questionnaire

Are you prepared to commit to a minimum of 100 hours over 6 months of service and a minimum of one four-hour shift per week?

Please tell us why you would like to volunteer at Beth Israel Deaconess Hospital Plymouth.

Please describe for us a time when you have interacted with someone who was ill or recovering from a physical or mental illness. What were your challenges and successes?

Please list and describe any volunteer positions you have previously held.

Please tell us about any work or life experiences that you think has prepared you to succeed as a hospital volunteer.

Do you have any special skills, talents or interests that you would be willing to share with us?

Emergency Contact

* Emergency contact's name

* Relationship

* Phone

Physician

* Physician's name

* Phone

Expectations & Commitment:

Be able to commit to one 4-hour shift per week totaling 100 hours over 6 months.
Be on time, reliable and consistent.
Be available to attend the mandatory orientation program. This is available every other Monday, 8:15-12:30.

All volunteers should notify the Volunteer Office as soon as possible if time off is needed for vacations, camps, retreats, etc., so we can schedule appropriately. The absence policy can be found in the Volunteer Handbook.

Excessive, unplanned absences, improper dress or manner, or any disregard for hospital or departmental policies and procedures will be grounds for immediate termination of volunteer assignment.

PLEASE NOT ALL VOLUNTEERS ARE REQUIRED TO HAVE THEIR MMR, TB, VARICELLA, FLU IN SEASON,THE ORIGINAL COVID SERIES PLUS ONE BOOSTER OR THE COVID BIVALENT VACCINE. This is provided by our Occupational Health department at no cost to you. You will be directed to Occ. Health after the interview process.

* Signature: (Typed name accepted as Electronic Signature)

* Date: