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BMC

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. We place volunteers based on skills, abilities and availability of positions. Before you're placed in an assignment, you'll go through a screening process. Start by filling out the form below.

Personal Information

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First Name

Middle Name

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Family/Last Name

Gender

*

Email

Volunteer Source

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Mailing Address

Line 2

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City

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State

*

Zip/Postal

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Primary Phone

Phone (Other)

Emergency Contact

*

Relationship

*

Name

*

Primary Phone

Phone (Other)

Volunteer Services

Type of Volunteer Assignment you prefer

Reason for Volunteering

Employment History

Current Employer

Current Position/Title

Length at current company

Previous Employer

Previous position/title

Length at previous company

Have you ever been employed by BH?

Education

Major/course of study

Graduation Date (MM/DD/YYYY)

School/Institution

Volunteer Experience

Volunteer Organization

Volunteer Position

Volunteer Duration

Interests / Hobbies

Skills

Interests / Hobbies

Authorization

Under the age of 18?

If yes, Please click box below and select birthdate from calendar

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)

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.

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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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