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Baystate Medical Center

Baystate Medical Center Volunteer Application

If you have previously submitted a volunteer application at Baystate Medical Center, please email us before submitting a new application.

Thank you for your interest in volunteering at Baystate Health. Please begin the application process by completing the form below. Note that fields left blank will delay processing of your application.

We welcome volunteers age 14 and older. Note that roles may be limited for volunteers less than 18 years of age.

Personal Information

*

First Name

Middle Name

*

Family/Last Name

* Preferred name

* Preferred Pronouns

Date of Birth (Optional for application. Will be required for background check)

Are you 18 years of age or older? (if between 14-17, remember to complete parental permission section at the bottom of this form)

Contact Information

*

Current Address

Current Address Line 2

*

Current City

*

Current State

*

Current ZIP

*

Primary Phone

*

Email

Preferred Contact Method (choose one)

Emergency Contact

*

Emergency Contact Name

*

Relationship

*

Primary Phone

Questions

Have you ever been employed by Baystate Health?

Have any of your family members been employed by Baystate Health?

If yes, tell us about the related family who are or have been employed at Baystate Health (parent/guardian, sibling, spouse, child, other).

If any information relevant to the next two questions (felonies and misdemeanors) is classified as a "sealed" record, then you may answer "No" to both questions:

Have you ever been convicted of a felony?

Have you ever been convicted of any misdemeanor or released from incarceration resulting from a conviction for a misdemeanor within the last five years?
(Do not answer 'yes' if it was a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violation, affray, or disturbance of the peace)

Employment & Education History

Are you currently employed?

Are you currently in school?

If so, what is the name of the school you are attending?

* Please tell us about your work and/or education history. This may include places you've worked, jobs you've held, schools you've attended, classes you've taken. Please contribute at least 75 words to allow us to get to know your background better.

Volunteer Role Categories

Please read through the available types of volunteer roles and make a selection. We will discuss your interests at the interview.

* Patient Care Assistance - Primarily interacting with patients in a department or unit

* Guest Experience - Primarily interacting with guests in a department, waiting room, or common area

* Administrative Support - Primarily interacting with other staff in an office setting

* Animal Assisted Therapy - You have a certified therapy animal you would like to bring to the hospital

* Spiritual Care - You wish to serve patients in a spiritual manner, such as a volunteer chaplain or Eucharistic minister

* Community Collaborator - You wish to do your service from home, such as by sewing, knitting, or doing projects

Type of role I am interested in:

Health Requirements

Have you had, or are you willing to get, the initial series of the COVID vaccine (single dose of the one-dose version, or double dose of the two-dose version)? Note that at least the initial series of the COVID vaccine is required in order to volunteer.

Availability

The expectation is that you will serve one consistent shift per week. Please indicate the days and times you are generally available to volunteer.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

About You

* Please tell us about you. This may include your interest in volunteering, your interest in the community, past experiences in volunteering, education, occupation, or life, hobbies, interests, or additional information that will help us in getting to know you. Please contribute at least 100 words to allow us to get to know you.

Authorization

I certify that all statements on this application are true and complete to the best of my knowledge. By typing my name in the Signature Field below I grant permission to Baystate Health (BH) to investigate references needed to complete the application process and I release the same from any liability resulting from such investigation. Volunteers who are at least 18 years old acknowledge that they will be subject to and must be cleared by a criminal background check. If selected as a volunteer, I understand that any omission, misrepresentation, or falsification of this record may be considered cause for termination. I further understand that as a condition of volunteering, BH requires that I be cleared through its own Health Services. If selected as a volunteer, I will be required to attend a Volunteer Orientation as well as additional training where necessary. I will be required to sign a Confidentiality Policy Statement. I agree to observe all hospital regulations and policies. I understand that volunteers are not covered by Workers' Compensation and that I am responsible for maintaining my own health insurance. I voluntarily offer my services with a clear understanding there will be no monetary compensation and that volunteering does not lead to employment.

*

Signature Field - Click in signature box to type your name

Date (MM/DD/YYYY)

To be completed by Parent/Guardian if under 18 years of age:
I hearby consent to my child serving as a volunteer for Baystate Health.

Parent/Guardian Name

Signature

Date (MM/DD/YYYY)

Baystate Health is a smoke free and drug free work environment. Reasonable good faith efforts are made to recruit and select volunteers on the basis of bonafide role requirements and affirmative action. Selecting volunteers is made without regard to race, color, religion, sex, age, national origin, disability, ancestry, sexual orientation, veteran or Vietnam era status or other factors unrelated to job performance, skills, knowledge, and abilities.

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