PFCC Application

*Required Fields

*Please select which you would like to volunteeer for



Personal Information

*Preferred Contact




*AVAILABILITY - During which hours are you available for volunteer assignments?




*Days








*Please check which areas you are interested in volunteering








Volunteer Information

*Do you want to have patient contact?




Volunteer Background Check

*Are you over the age of 18?




*Have you ever worked for Bakersfield Memorial Hospital?




*Have you ever been sanctioned by the Office of Inspector General of the Department of Health and Human Services, (HHS/OIG) or the Government Services Administration (GSA) or excluded or suspended from participation in any federal or state healthcare program?



Physical and Medical Background

*Are you able to perform the essential functions of the volunteer position with or without accommodation?



References

Applicant's Pledge

*I certify that answers by me to the foregoing questions and statements are true and correct. I agree to a health screening and understand that placement in the Volunteer Services Program at Bakersfield Memorial Hospital is contingent upon successfully passing the background check and health screening. I also understand that falsification or material omission of facts on this application may result in the rejection of my application or my dismissal. I also authorize Bakersfield Memorial Hospital to contact any references and other sources deemed appropriate (with the above restrictions) to consider my volunteer application. I understand that all candidates selected for the volunteer program will have to submit to a background check. I hereby release them and Bakersfield Memorial Hospital from any and all liability for issuing, receiving, and using any such information. I agree that, if accepted, I will abide by the philosophy and all policies and procedures established by Bakersfield Memorial Hospital. I further understand that either the hospital or I can terminate my role as a volunteer for any reason. I understand that being a volunteer at Bakersfield Memorial Hospital is not a lead to employment.

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