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Community Hospital Anderson?

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Personal Information

Teen Volunteers Only (16-17 years of age)

Additional Information

Personal References

Do NOT list relatives or former employers:

Reference 1:

Reference 2:

Job, Volunteer or Community Service Experience and Affiliations:

List below most recent employment or volunteer experience.

Be sure to include previous employment with Community Hospital Anderson and any military experience.

Preferences / Availability

Please check all special skills and interests:

Availability (Check all that apply)



I will consider as confidential all information which I may hear directly or indirectly concerning a patient, a doctor, or any member of hospital personnel. I will not express curiosity in regard to a patient beyond the carrying out of my duties.

The facts contained in this application are true and complete. I understand that if I became a volunteer, any false statements on this
application will be cause for release from the program. I authorize Community Hospital Anderson to contact my current and/or
former employers or volunteer agencies and any other person who may have information bearing on my suitability for volunteer
work. If accepted as a volunteer, I will fulfill my commitment of service and maintain annual education and health testing. I
authorize Community Hospital Anderson to complete the Criminal History Check.  

General Information for Volunteer Applicants

Health Screening: TB screening is required with the Employee Health Department located at Community Hospital
Anderson. A flu shot is also required. These are provided at no cost to the volunteers.

Criminal History Check: All new volunteers over the age of 18 must pass a criminal history background check by the
Indiana State Police.

Orientation: all volunteers are required attend volunteer orientation. You will be given important resources that should
be studied. Additional training will occur, depending on your specific volunteer assignment. In some cases, you will
shadow a current volunteer or hospital employee in your designated area.

Uniforms: Uniforms are provided to each volunteer. A name badge will be provided and is to be worn on your uniform
at all times. Uniforms must be worn while volunteering. The dress code consists of black, khaki or white pants, the
under shirt of your choice, with your Community Hospital Anderson smock, vest or polo shirt over it. Shoes must be
closed toed and heel covered. When a volunteer ends their service to the hospital, they are required to turn in their
name badge to the Volunteer Services office.

Parking: Parking is free. You will be instructed on where to park in Orientation.

Meal: One free meal (totaling $7 or less) will be provided on the day you volunteer.

Sign in/out: Volunteers sign in and out using a touch screen computer. You will be trained on this procedure. Service
hours are tallied from these records, as well as annual hospital reports and are available for you for scholarship
applications, tax purposes, etc.

Attendance: Volunteers and staff have a better experience if volunteers commit to a consistent schedule. If you cannot
volunteer due to illness, vacation, etc., please contact the Auxiliary office at 765-298-5100 or the CHA employee with
whom you volunteer.

Again, welcome to our team and thank you for helping us always create exceptional experiences for our patients,
families, staff and guests at Community Hospital Anderson. If you have any questions, please don't hesitate to contact
us. We look forward to working with you!

Lorie Staehler
Volunteer Services Director