________________________________________________________________________________________________________________________
If you checked other: Why do you want to volunteer at Akron Children's Hospital?
________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Are you currently employed
Reason for leaving previous company
Are you currently a student?
________________________________________________________________________________________________________________________
What type of volunteer assignment do you prefer? (Check all that apply)
Errands/Transport
Gift Shop (Mahoning Valley Only)
Patient and Community Support
Wherever Needed
________________________________________________________________________________________________________________________
A record of criminal conviction will not necessarily be a bar to volunteering, since the Hospital will consider factors such as age at time of offense, how long ago the conviction occurred, the nature and seriousness of the violation and evidence of rehabilitation in making a volunteer decision. Since Children's is a pediatric hospital, certain criminal offenses are by Ohio law automatic disqualifiers for volunteer assignments no matter when they occurred.
In the past seven years, have you been convicted of (plead guilty, no contest, or been found guilty) an
offense other than minor traffic violations?
Are you charged with a crime that has not yet resulted in a plea of guilty, court trial, deferred
adjudication, or dropping of the charge?
If yes to any of the questions above, please explain fully by listing the conviction, the date, and county/state where convicted (failure to disclose a conviction may be considered falsification of your application and disqualify you from consideration for volunteering or result in termination even if discovered at a later date):
If yes to any background check question, please explain:
Since Akron Children's Hospital and its affiliated companies are responsible for children in out-of-home care as defined by S2151.86 (A) (1) of the Ohio Revised Code, the organization must first submit to the Bureau of Criminal Identification and/ora the Federal Bureau of Investigation your fingerprints and general information in order that a background check be conducted to ascertain whether you have been convicted of certain crimes which might disqualify you from eligibility to volunteer. Any applicant who fails to provide the information necessary to complete the required forms or fails to provide impressions of their fingerprints will not be accepted to volunteer for any position.
Your acceptance to volunteer is contingent upon the aforementioned records check not revealing any disqualifying criminal offenses. If you begin volunteering prior to the receipt of this information, volunteering will be conditional. If the records check reveals your conviction of any disqualifying offenses, you will be released from volunteering.
________________________________________________________________________________________________________________________
I hereby affirm that the information provided on this application is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for volunteer service and may result in discharge even if discovered at a later date. I understand the terms and conditions of my submission to the background check.
I authorize Akron Children's Hospital to verify any information I have provided. I hereby authorize persons from any schools, companies, or organizations, to include my references, named in this application to provide information about me contained in their records, and I release all such persons from liability regarding the provision of or use of such information.
I understand there are certain training requirements that must be fulfilled, and performance standards that must be maintained in order to volunteer at Akron Children's Hospital.
Finally, as an Akron Children's Hospital volunteer, I will:
Agree to volunteer for a minimum of one year and 50 hours within that year
Notify Volunteer Services any time I am unavailable to volunteer for my assignment
Respect patient, family, and staff confidentiality
Abide by the rules and regulations of Akron Children's Hospital and Volunteer Services
Maintain the customer service standards in my interactions with patients, families, and staff
Permit images of photos of me in my role as a volunteer to be used in public relations brochures or videos
Give permission for a background check to be performed by Akron Children's Hospital Security Department
