Ascension Wisconsin Volunteer Application

1. I understand that my services are voluntarily donated to Ascension without expectation of compensation or future employment.
2. I understand that I am committing to volunteering a minimum of 6 months or 60 hours of service. I am expected to report as scheduled and follow the procedures for attempting to find a substitute, if required, for my volunteer position.
3. Within a three (3) month orientation period, I agree to be reviewed by the department designee to evaluate if my placement is in the best interest of myself and the department. Thereafter, periodic reviews may be completed to evaluate my volunteer performance.
4. I understand that final documentation of service hours will not be verified and reference or recommendation letters will not be given in the event I volunteer less than 6 months or less than 60 hours.
5. I authorize a Criminal and Health Care Background check, a Health Care Sanction and reference check and understand that information received from this application will be used for determining my eligibility for volunteering. I release from any and all liability all representatives of Ascension for their acts performed in good faith and without malice in connection with evaluating my volunteer application. I further authorize any party having information bearing upon my qualifications to release such information to Ascension and also release any party from liability in sharing this information with Ascension. I also authorize Ascension to release similar information to prospective employers.
6. I understand information obtained as a part of this application and process may be disseminated as appropriate to other Ascension entities.
7. I consent to any initial screening required by Ascension, which may include a drug screen and a blood draw to test for TB and immunities to measles, mumps, rubella and varicella (chicken pox). I understand that the successful completion of the initial and any future screenings is required.
8. I understand and agree to comply with the policy of Ascension which requires seasonal influenza immunization on an annual basis.
9. I agree to complete periodic training. Federal and health care accreditation agencies require continual education for all volunteers.
10. I shall always uphold the mission, values and standards of behavior for Ascension and the Volunteer Services Department.
11. I understand Ascension has a smoke-free and drug free policy and that I will be required to comply with these policies.
12. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status as a result of:
    (A) failure to comply with policies, rules and regulations
    (B) absences without prior notification
    (C) unsatisfactory attitude, work or appearance
    (D) any other circumstances which, in the judgment of the department manager, would make my continued services as a volunteer contrary to the best interests of Ascension.
    
13. Should I become ill or sustain an injury while volunteering I authorize medical care/treatment and understand my medical  insurance may be billed. If the volunteer is under the age of 18 or legal guardianship and a parent/guardian cannot be reached, I as the parent/guardian authorize medical care/treatment of my child/ward and understand their medical insurance may be billed. I have reviewed, understand and agree to the above conditions. I certify that my statements in this application are true and complete and I authorize investigation of the statements I have made. I understand that falsification of this application constitutes grounds for rejection or termination from the volunteer program.

Ascension Wisconsin is an equal opportunity employer (EEO) and affords equal opportunity to all associates, volunteers and applicants without regard to race, color, religion, national origin, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status.