Volunteer Application

Please fill out and submit this form for an opportunity to volunteer at BJVIM.

New Volunteer Form

Date
Name
Address
Birthday
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What Clinical Position(s) are you interested in at VIM?
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Nurse/Clinical Assistant:
Patient Relations Positions:
Special:
What are your preferred days to volunteer?
What are your preferred hours to volunteer?
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Volunteer Code of Conduct

The primary mission of the Volunteers in Medicine Clinic is to understand and serve the health and wellness needs of the medically underserved population living and/or working in Bluffton and Jasper County. In working with our patients, their confidentiality is of utmost importance to the work we do here.

I shall:
 1. Uphold the philosophy and standards of VIM;
2. Not seek to obtain confidential information from a patient unless it is in the course of my job responsibilities;
3. Maintain all information that I obtain concerning patients, doctors and staff as confidential.
4. Conduct myself with dignity, courtesy and consideration of others, and endeavor to be professional;
5. Be punctual, conscientious and dependable;
6. Make my best effort to fulfill my commitment to VIM by completing all assignments; and
7. Bring to the attention of the Coordinator of Volunteers any problems that impact my ability to meet the above standards, or that impact the VIM standards.

I agree to:
 1. Wear my ID badge;
2. Review the schedule and alert the Coordinator of Volunteers of any scheduling conflicts; and
3. Submit to immunizations (TB, Hepatitis B, etc.) that may be necessary.

I understand that VIM reserves the right to terminate my volunteer status as a result of:
1. Failure to comply with VIM policies, rules and regulations;
2. Excessive absences without prior notification;
3. Unsatisfactory behavior or attitude not in the spirit of VIM; and
4. Any other circumstance that would make my continued service contrary to the best interest of VIM.
Terms and Conditions(Required)
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