Rhode Island Hospital Volunteer Application

Volunteer Services requires that all volunteers give a minimum commitment of 100 hours (typically this is one 4-hour shift per week over the course of six months or more). Please indicate the days and shifts in which you are interested. 

We’d love to know more about you. Please answer the following questions.

Please read carefully,

I agree to comply with all hospital policies, including, but not limited to, protection of patient privacy and confidentiality. I affirm that all information provided on this application and accompanying material is complete and true. I understand that my acceptance into the volunteer program is contingent upon satisfactory results of my health screening, criminal history check and other information provided by me. I understand that completing this application does not guarantee a volunteer position. I understand that the hospital reserves the right to terminate my service as a volunteer when, in the opinion of the director of volunteer services, such action is warranted.

Application Release and Authorization Form

I hereby authorize Rhode Island Hospital and/or Hasbro Children’s Hospital or other authorized representatives, to obtain any information pertaining to my volunteering, military, credit, criminal, driving record, workers’ compensation claims, or educational records including, but not limited to, information concerning academic achievement, attendance, disciplinary actions, character, work habits, performance, experience and reasons for termination of past employment.

I hereby direct you to release such information upon request of Rhode Island Hospital and/or Hasbro Children’s Hospital or other authorized representative. I hereby fully release and discharge Lifespan and/or Rhode Island Hospital and/or Hasbro Children's Hospital as my prospective organization or other authorized representatives of the company, their affiliates, employers, agents, attorneys and any individual organization, entity, agency or other source providing information to my prospective organization from all claims and damages arising out of or relation to any investigations of my background for volunteer purposes. This release is valid for most federal, state and county agencies.

I agree that providing my name electronically to this agreement is the legal equivalent of my manual signature and that all information contained in this application is accurate.

In accordance with R.I. General Laws Chapter 11-37.3, I certify that I am not currently registered, or required by law to be registered, as a sex offender in Rhode Island or in any other jurisdiction as a result of being convicted of a sexual offense against a minor. If during my period of service at any Lifespan affiliate, I am convicted of a relevant offense and am required by law to be registered as a sex offender in Rhode Island or in any other jurisdiction, I will immediately notify the Volunteer Office of this change. If this occurs, or if I fail to so notify the Volunteer Office of such a change in my status, I understand that my service period may be immediately terminated. 

I have a continuing obligation to notify Volunteer Office of any arrest or criminal conviction that occurs while I am at any Lifespan affiliate so that Lifespan can assess whether such arrest or conviction has an impact on continuing service.  I understand decisions regarding whether I may continue my services rests with Lifespan administration and failure to comply with this notification requirement can result in immediate loss of placement and stature.  

I agree that providing my name electronically to this agreement is the legal equivalent of my manual signature and that all information contained in this application is accurate.