Junior Volunteer Summer Program Interviews Now Being Scheduled 

Lawrence Memorial Hospital is accepting applications for its Junior Volunteer Program.  The program gives area junior high and high school students an opportunity to experience working in the hospital environment.  The program is sponsored by the LMH Auxiliary and is under the direction of the Volunteer Services Department.

Participants must be:

• at least 14 years old   
• available to work at least one 3 hour shift a week,
• interested in helping in your community, and
• possibly interested in a health care career  

All students interested in becoming LMH Junior Volunteers should make an appointment for a short interview.  To set up an interview, please call the Volunteer Services Office at 505-3146.  

At the interview, please bring the following items:

• Completed application, including a brief essay about why you wish to be a Junior Volunteer and
• A letter of reference from a teacher or an adult other than a family member. 

All new volunteers accepted to the program will need to attend an orientation session. More information about orientation will be provided at the interview. 

Returning volunteers need to complete the application and set up an interview, at which we will discuss the area and time you would like to volunteer.  Let us know early that you are returning! We give returning volunteers preference of when and where they volunteer.  

Being a Junior Volunteer at LawrenceMemorialHospital is a great way to make a difference.  Besides learning about the hospital environment, Junior Volunteers find out for themselves the satisfaction that comes from helping others.

If you have questions, contact us (785) 505-3146 or via e-mail at Lauren.Cobb@LMH.org.   

Volunteer spaces are limited.

Deadline for applications is May 16.  

Junior Volunteer Application Summer 2014

Name:   ____________________________________________________

Address: ____________________________________________________

City, ST, Zip: ____________________________________________________

Phone (home) _________________     (cell)  ________________

T-shirt size ______

Age: ____   Date of Birth: __________________    

E-mail address:  _____________________________________________________

Do you check your e-mail regularly?   __yes  __ no

School in 2014-2015: _________________________________

Grade in 2014-2015: _________  GPA ______

Career Plan: ___________________________________________________

School Interests/Activities:  ___________________________________________________

_________________________________________________________

Other Hobbies/Activities: ______________________________________________________

______________________________________________________

How did you hear about volunteering at LMH?_______________________________________

Other volunteer experience _______________________________________________________

_______________________________________________________

Are you volunteering to fulfill a community service requirement?  __yes  __ no

If yes, please complete the following:

Name of organization______________________________________________

Number of hours required __________   

Required date of completion ___________

Do you have family or friends who work or volunteer at LMH?

__yes     __ no

If yes, who?_______________________________________________________

Parent/Guardian: ________________________________________  

Relationship: _________________

Phone: (home)__________________  (work) ___________________ (cell) ___________________

Other Emergency Contact: ________________________________   

Phone: _____________________

Please indicate which shifts you prefer:

Parental Permission for Volunteering 

As the parent/guardian of _______________________, I authorize him/her to participate in volunteer activities at LawrenceMemorialHospital.  We release LMH from any claim or liability for an injury or illness resulting to said minor, not occasioned by any fault or neglect on the part of the hospital, while participating in such volunteer activities.

______________________________________         __________________

Parent/guardian signature                                          Date

Parental Permission for TB Testing

 I give permission for Lawrence Memorial Hospital to test _____________________________ for TB.  I also acknowledge that if my child’s TB test reads positive that a chest X-ray will be required for further diagnosis.  There are two options of my choice for chest X-rays (please check your preference):

       ___ BusinessHealthCenter at LawrenceMemorialHospital free of charge

       ___ My own personal physician at my own cost

I understand that if my child’s TB test results are positive that does not necessarily mean that my child has contracted tuberculosis and realize that is the reason for the chest X-ray.  Regardless of where my child’s chest X-ray is performed or the results of the chest X-ray, I understand that my child will be referred for follow-up at either their primary care physician or at the Lawrence-Douglas County Health Department.

_______________________________              ____________

Parent/Guardian Signature                              Date

Confidentiality Statement

Your job may bring you into contact with patient records and information or place you in a position to hear discussions of patient care.  Any information you see or hear concerning a patient's diagnosis, condition, treatment, financial or personal status is STRICTLY CONFIDENTIAL.

Patients desiring privacy are to be granted privacy.  Personnel who discuss the presence of a particular patient in LawrenceMemorialHospital may be violating that right of privacy.  For this reason, you are not to discuss, either inside or outside the hospital, or on the internet, the identity or condition of any patient with anyone not directly concerned with their care.  You may discuss such information only as part of your assigned duties.  Medical information should never be disclosed to anyone.

A breach of these rules violates hospital and medical ethics and could have legal consequences for both you and the hospital.  Inquiries from the news media regarding a patient should be directed to the Director of Community Relations or the Hospital Executive Director.

I understand and agree to abide by the above policy.  I understand that if I violate the above policy, the Volunteer services Department may discipline me, up to and including asking for my resignation as a volunteer.

______________________________________                 ____________

Volunteer Signature                                                      Date

Applicant Acknowledgement

Believing that the hospital has real need for my services as a volunteer worker, I will be punctual and conscientious in the fulfillment of my duties and accept supervision graciously. I understand that I am making a commitment of one shift of service per week between June 2 to July 25 to the hospital.  Less of a time commitment represents a waste of resources for the hospital, as it does cost money to prepare me for my volunteer assignment. 

I will conduct myself with professionalism, responsibility, integrity, dedication and excellence.   I will endeavor to make my work of the highest quality and uphold the traditions and standards of this hospital.

The information I have provided is true.  I understand that any false statement or material omission will impact my ability to start and/or keep volunteering at LMH. In order to provide the best patient care, I understand that LMH may verify or investigate my background.  I give permission to do this.

______________________________                 ____________

Volunteer  Signature                                              Date

Please write a brief statement about why you wish to be a Junior Volunteer:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you! Please contact Lauren Cobb at

(785)505-3146 or Lauren.Cobb@LMH.org to schedule an interview.

Deadline for applications is May 16.