Welcome to the application portal for Enloe Health Volunteers

VSys Web application

Flu Clinic Volunteer Application

Are you currently an employee of Enloe Health?

Are you over 18 years of age?

Are you a Registered Nurse with an active license

If applicable, please enter your RN License #

If applicable, please enter your RN license expiration date

Are you a Butte College nursing student?

Are you a Chico State nursing student?

Please indicate the shift(s) your preferred shift(s)

PLEASE TELL US ABOUT YOU

* First name

* Last name

* Preferred name

* Date of Birth

* Mailing Address

* City

* State

* Zip/postal

* Phone (Preferred)

Phone (Secondary)

* E-mail

IN CASE OF AN EMERGENCY PLEASE NOTIFY:

* Contact name

* Relationship to you

Street Address

City

State

Zip/postal

* Phone (Preferred)

Phone (Secondary)

* Physician

* Physician Phone Number

EMPLOYMENT AND EDUCATION

Are you currently a student?

School at which you are currently enrolled:

Employment status

Current or last place of employment

Are there any work activities or conditions that you must avoid?

If yes, what activities must be avoided:

Have you ever committed, been convicted of, pled guilty to or pled no contest to a felony or a misdemeanor?

If yes, please explain

The information provided in this application is true in all respects, without any willful omissions. I understand that if this application is false in any way, I will be dismissed without notice regardless of when the false information is discovered.

* First Name:

* Last Name:

I hereby authorize Enloe Health to use photographs taken of me for marketing, public relations, recruitment, identification and educational purposes and waive any right to compensation for these uses. The term photograph shall mean motion picture or still photography in any format, as well as videotape, video disc, digital, electronic or other mechanical means of recording and reproducing images.

By entering my name below I agree to the above statement.

* First Name:

* Last Name:

* Application date

Please review the following safety guidelines as a requirement of your Short-Term Episodic Volunteer assignment.

Excluding licensed RN's, your assignment is expected to be non-clinical in nature with the primary area of service having no or very limited exposure to the clinical environment.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

You will not be expected to assist with any hands-on direct patient care. Any requests for care from the patient should be referred to the staff.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

If there is a risk of exposure to the patient's blood and/or body fluid, you will be provided with protective equipment according to Standard Precaution.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

In the event of an emergency related to the patient or visitor's physical condition, notify the staff immediately.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

In the event of an Emergency requiring a facility wide response, staff will give you direction regarding your role during the emergency.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

In the event of a fire, notify the staff to initiate the fire plan. You will be given information by staff regarding location of emergency exits.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

There will always be a staff member assigned to supervise your activity. In the event of unusual occurrences, alert the nearest staff member for direction.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

CONFIDENTIALITY: All conversations between a patient and his/her physician regarding medical condition or medical history are confidential. This also includes any conversation overheard regarding any other patient.

By entering my name below, I agree to the above statement.

* First Name:

* Last Name:

* Safety Orientation/Acknowledgement Date

I understand that this is a short-term assignment only and that any regularly scheduled service beyond this assignment will require completion of the full intake process for Volunteer Services.
My services as a volunteer of Enloe Health are being donated for humanitarian, religious, charitable or educational reasons.
I understand that while volunteering I represent Enloe Health and agree to not engage in behavior that would be contrary to the best interests of the hospital.
Any patient information that I may hear, observe, read, or learn about in any fashion will be treated as confidential. I will not discuss or disclose information about patients, staff and/or families.
I will observe the appearance policy required by Enloe Health.
If my placement involves direct public contact, I verify I am in good health and do not have any communicable diseases.
I have read, understand, and have electronically signed the Safety Orientation information.
I agree to comply and complete any on the job training or competency review applicable for this activity.

By entering my name below, I indicate that I agree to abide by the rules outlined above, and any other applicable policies and procedures of the hospital.

* First Name:

* Last Name:

* Today's Date