Junior Volunteer Application


Thank you for your interest in volunteering at Bozeman Health!


Please complete this application.

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.

Our goal is to provide a positive, safe, and rewarding experience.


We look forward to welcoming you to the

Bozeman Health Junior Volunteer Program!


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


STEP 2: HEADSHOT

Please follow these guidelines.


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


Please upload ALL required documentation here.

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

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

Drag and drop files here or

PERSONAL INFORMATION

You must be 16 or 17 years old.

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Phone

VOLUNTEERING

Which opportunity are you interested in?

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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.


  • Agree to fulfill the 24-hour/3-month 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 notify Volunteer Services when I’m going to be absent.
  • 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.


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.

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

Your information will remain confidential.


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.


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:


  • Immunizations
  • Lab Reports