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Auxiliary Volunteer Application Form

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Acknowledgment:

The responses given above are true and correct. I have not withheld any fact which might adversely affect my application and I understand that any omission of fact or any false or misleading statements will be considered just cause for not being offered a volunteer role at Parkland Health Center.

I agree that former employers and personal references may furnish information about my character and qualifications and I release said persons from any liability regarding the provision or use of such information.

I further understand and agree that a criminal background and abuse check will be conducted on me, previous to serving in a volunteer capacity. I also understand and agree to submit to a urine drug screen process; to view mandatory infection control and safety videos; and to abide by hospital policies and procedures, including HIPAA regulations (which indicate I am not free to discuss ANY patient information I hear or see with anyone).

I agree to read my orientation packet and participate in volunteer education day as requested.

I agree to complete the required paperwork if my application is accepted.

If I have a concern about my auxiliary service, I should discuss the concern with an auxiliary officer or with the Human Resources Director.

I understand I must be physically fit to be a volunteer, able to ambulate on my own accord without use of a walker or cane. I further understand that if my physical condition declines, I may not be able to continue to work as a volunteer.

I understand there is an annual dues fee of $2.00 to be an auxiliary member. The dues fee is payable before the auxiliary member is allowed to volunteer and should be submitted in check form to: Auxiliary Treasurer, 1101 West Liberty, Farmington, Missouri 63640.

Find a doctor or make an appointment:
573.431.3338 OR CALL TOLL-FREE 800.392.0936
General Information:
573.756.6451 OR CALL TOLL-FREE 800.734.3944
Copyright © 1997-2019. BJC HealthCare. All Rights Reserved.
Parkland Health Center -- Bonne Terre
7245 Raider Road | Bonne Terre, Missouri 63628
phone -- 573.358.1400
Parkland Health Center -- Farmington
1101 West Liberty Street | Farmington, Missouri 63640
phone -- 573.756.6451