RMC Adult Volunteer Application
Thank you for your interest in volunteering at Regional Medical Center of San Jose. Below is our online application form for adults (18 yo or above).

On-boarding application deadlines are as follows:

Application Deadline Interview Dates Orientation
February 1 February 9-20 March 3-10
June 1 June 11-22 July 2-8
August 1 August 10-21 September 1-8
October 1 October 5-15 November 3-10


All new volunteers must be medically cleared by our employee health services (tuberculosis, drug screening, immunization records and proof of immunity) and be willing to have a background check performed. After you are cleared by Employee Health and Human Resources, you will attend an Orientation and Training session before being placed in a service. Most volunteers come once a week for 4 hours; a minimum commitment of 6 months of service or 100 hours is anticipated.

Unless otherwise specified, all new volunteers are placed at the Front Desk and/or Dispersal area for a minimum of 3 months. Please check our website for more information and current positions.

Thank you.

Today's Date
MM/DD/YYYY
Your answer
Name
LAST, FIRST
Your answer
Gender
Date of Birth
MM/DD/YYYY
Your answer
Age
Number only
Your answer
Address
Street, City Zip
Your answer
Best Contact Number
(XXX) XXX-XXXX
Your answer
Text Messages?
Email
Your answer
Are you presently employed?
If currently employed, list current employer, position, and job title
Employer, Position/Job Title
Your answer
Are you currently attending college?
If currently in college, state college attending
Your answer
If currently in college, state major
Your answer
Is volunteer work a requirement for college credit?
If volunteer work is a requirement, how many hours?
Number only
Your answer
Have you ever been convicted of a felony or misdemeanor?
Please describe your previous volunteer experience, if any.
Limit your response to 1 paragraphs or less
Your answer
What is/are your reason(s) for volunteering?
Limit your response to 2 paragraphs or less
Your answer
Desirable times for you to volunteer?
ONLY select times you know you are available, over selecting is not appropriate. Time slots are not absolute, for example, if you are available from 2pm to 5pm, you can select 3pm to 6pm.
Required
Are you interested in volunteering in the Emergency Department as an "ED Patient Advocate"?
Placement dependent on volunteer's availability and/or experience
In an emergency notify
Name, Telephone Number
Your answer
Please read the rules and regulations below carefully. If accepted as a hospital volunteer, I agree that:
1. My services are donated to the hospital for humanitarian, religious or charitable reasons. I expect no payment, benefits or future employment. I do not expect to receive the minimum wage or overtime for my services. I will serve a minimum of 4 hours per week and commit to a schedule for at least 3 months. 2. I will serve a minimum of 6 months and for a minimum of 100 hours. 3. If unable to come in on my assigned day or time I will contact the Manager of Volunteers to inform and reschedule to make up the lost time. I understand that 3 unexcused absences is cause for terminating my membership as a volunteer. I also understand that failure to notify the department of an absence is considered unexcused absence. 4. I am willing to serve wherever I am needed at the hospital. 5. I understand that I will be taking orders and following directions from the Volunteer members, Junior Ambassadors, hospital personnel, Administration and other staff. (If you have difficulty doing this, you should reconsider serving as a volunteer) 6. I understand that only white pants or skirts, white shirt and volunteer jacket are to be worn while on duty and that my appearance will be neat and clean. If you are assigned to volunteer in a specific department, you may be assigned a different uniform. 7. I shall submit to examinations including TB screen, drug screening and blood test, as well as an annual flu shot that are necessary as part of my volunteer service. I authorize the person taking the tests to report the results to Regional Medical Center of San Jose. 8. I shall be punctual, conscientious and endeavor to make my work and conduct professional in quality. I will attempt to resolve any problems related to my volunteer activities with the President of Volunteers. If unsuccessful, I will speak with the Director of Volunteer Services. 9. I shall at all times uphold the philosophy and standards of the hospital. 10. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status in their own sole discretion at any time.
I hearby certify that I have read and understood all statements and questions on this application and my responses are true and complete to the best of my knowledge. I understand that any false representation, misstatement or omission may be basis for immediate dismissal.
Please type your initial below (e.g. if you are Joe Toogood, you type JT)
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms