College StudentVolunteer Application

College Student

Volunteer Application

Thank you for your interest in volunteering at Bozeman Health!

Begin by completing the information required in steps 1-2.

Once those steps are complete, fill in the remainder of the form.

These steps are required to ensure your safety,

patient safety and confidentiality.

We look forward to welcoming you to the

Bozeman Health Volunteer Program!

Additional Support:

If you need additional support completing this form,

contact the Volunteer Department: volunteer@bozemanhealth.org

CHECKLIST

Carefully follow the submission instructions for each of the following steps.

Indicate completion of each step by checking the box below each step.

Please complete ALL steps before submitting. Partial completion cannot be accepted.

STEP 1: IMMUNIZATIONS

Immunizations are not mandatory, but the hospital is required to maintain records of immunizations that are voluntarily submitted. If you wish to, please submit proof of the following vaccinations:

Annual Influenza Vaccine
Annual Covid Vaccine
TDAP

YES! I will upload relevant vaccination proof.

NO. I prefer not to disclose vaccination status.

STEP 2: HEADSHOT

Please follow these guidelines.

You are the only person/object in the frame
Neutral background
No black and white pictures > full color only
No hats, sunglasses, or distracting accessories
Consistent lighting/no shadows
Your headshot should convey a professional image

YES! I have uploaded a headshot.*

Upload ALL required documentation here.

You will not be able to upload additional documents after submission. Please ensure all documents are uploaded.

Acceptable files are jpeg, jpg, png, doc. HEIC's are not acceptable.

If you are having difficulties uploading files, please email attachments to volunteer@bozemanhealth.org.

File Upload

Drag and drop files here or

PERSONAL INFORMATION

Full Legal FIRST Name*

Middle Name*

Full Legal LAST Name*

Street Address*

City*

State*

Zip code*

Date of Birth*

Gender*

Select or enter value

Contact Number*

Please double-check that telephone number is entered correctly, as we do use it to contact you.

Phone

Email Address*

VOLUNTEERING

Which opportunities are you interested in?

Availability changes regularly. We cannot guarantee placement in your preferred choices. The NICU Cuddler program is at capacity.

Choice 1*

Select or enter value

Choice 2*

Select or enter value

Choice 3*

Select or enter value

Are you 18 years old or older?*

Select or enter value

Are you a Bozeman Health Employee?*

Select or enter value

Can you meet the 40-hour volunteer commitment?*

This is a commitment and should be treated in the same manner as a job.

Select or enter value

How long are you planning on volunteering?*

Why do you want to volunteer?*

Have you ever been convicted of a criminal offense*

Select or enter value

Please Explain.

How did you hear about the volunteer program?*

VOLUNTEER AGREEMENT

IMPORTANT > Volunteer Responsibilities

As a volunteer, I have a responsibility to complete and adhere to the expectations of Bozeman Health and the volunteer services department.

Do not complete/submit this form if you cannot meet these requirements.

AGREE to fulfill the 40-hour volunteer commitment at Bozeman Health.
AGREE to attend volunteer training until I am competent to perform the required duties and will attend additional training sessions as needed.
AGREE to uphold the Mission, Vision, Values, and the Code of Conduct of Bozeman Health.
AGREE to comply with all policies and procedures of Bozeman Health and the volunteer services department.
Understand that I may have to relinquish my volunteer responsibilities at the sole discretion of Bozeman Health.

I agree to abide by all Bozeman Health policies and procedures as outlined above.*

BACKGROUND VERIFICATION DISCLOSURE

As part of the volunteer and employment process, Bozeman Health may obtain a Consumer Report and/or an Investigative Consumer Report. The Fair Credit Reporting Act as amended by the Consumer Reporting Reform Act of 1996 requires that we advise you that for purposes of employment and volunteering, a Consumer Report may be obtained which may include information about your character, general reputation, or personal characteristics. Upon written request, additional information as to the nature and scope of the report, if one is obtained, will be provided, in the event the report contains information regarding your character, general reputation, or personal characteristics.

Click here for a summary of your rights under the Fair credit reporting act.

Authorization and Release

During the application or volunteering process, and at any time during any subsequent employment or volunteering, I hereby authorize Victig, on behalf of Bozeman Health, to procure a Consumer Report that may include information regarding my character, general reputation, or personal characteristics. This report may be compiled with information from credit bureaus, courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification; to the extent such investigation includes information bearing on my character, general reputation, or personal characteristics.

Social Security Number*

In order to complete your background check, please provide your SSN.

Your information will remain confidential.

I hereby authorize and release information provided in this application for the purposes stated above.*

CONFIDENTIALITY COMMITMENT

As a Bozeman Health volunteer, I recognize that assuring confidentiality is an ethical, moral and legal responsibility. Patients, employees, and business associates of Bozeman Health have the right to expect that confidential information of all kinds—medical, personnel, business and financial (verbal, written or computerized)—will be safeguarded. Such information may be accessed, used, and discussed only by those with an authorized need to know, and may not be released or disclosed, except in accordance with Bozeman Health policies and agreements.

I recognize that due to the nature of my involvement with Bozeman Health, I agree to be obligated to follow Bozeman Health policies that protect confidentiality. These policies protect the confidentiality of patient health care information and of strategic business and financial information. Furthermore, I understand that these policies may be amended and new policies may be issued that protect the confidentiality of information, and I agree to follow such new policies as they are issued. Furthermore, I understand that, under special circumstances, Bozeman Health will enter agreements to share confidential business, financial or patient-related information with outside persons or organizations, with the obligation to hold such information in confidence. I agree to abide by such agreements.

I understand that failure to protect the confidentiality of information may be grounds for civil penalties under the Montana Health Information Act or the Health Insurance Portability and Accountability Act (HIPAA) and violation of Bozeman Health policies and agreements that protect the confidentiality of information will result in disciplinary action, which may include termination.

If I have a question or concern about Bozeman Health policies and expectations regarding confidentiality, I will ask my supervisor, department manager, a member of senior leadership, or the Compliance Officer. If I know of a breach or possible breach of confidentiality, I also recognize that I am obligated to report that breach to my supervisor, department manager, or the Compliance Officer.

Confidential Agreement*

DISCLOSURE OF PROTECTED HEALTH INFORMATION

I authorize Bozeman Health Deaconess Hospital to access my health records for the purpose of verifying my records related to: