EMC - Volunteer Form

EPIC Medical Clinic Volunteer Application
Thank you for considering to apply to volunteer for EPIC Medical Clinic. Please review the requirements listed below to volunteer at EPIC Medical Clinic.

*Please note that applying for a volunteering position does not guarantee the opportunity. Following the completion of this application, you will be contacted via email if you qualify to move forward to the next step of having an interview with the Clinic Leads.*

Requirements for all Volunteers:

1- Have an active HIPAA certificate. Complete the training below and send us the certificate.
https://courseforhipaa.com

2- Minimum age required to volunteer is 18 years.

3- We require scrubs for all staff (except MDs). You can purchase one from Walmart and the cost is about $12 for both shirt and pants. The color could be black or dark blue.

4- We require you to do one entire session, where you will shadow another MA and see if this is a good fit.

5- You are required to take at least 10 shifts in the course of 12 months. One each month, so you are more frequent and aware of all the changes and updates.

If you meet the above requirements, you may proceed to fill this application.
Name *

First Name Last Name
Volunteer As *
E-mail *
Date of Birth *

Month Day Year
Date
Contact Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Preferred Day *
How many hours are you available to volunteer per month *
How long do you think you will stay and volunteer with EPIC Medical Clinic *
Describe your medical experience (if any) *
Have you worked with any EHR (Electronic Health Record) System *
What motivates you to commit to volunteering with EMC *
Describe a time when you made a mistake and how you corrected it. *
Describe a time where you exceeded expectations. *
Describe an event when you handled a situation under stress. *
Anything you would like to share about yourself that would be beneficial for this position *
Please attach your resume. *

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EPIC Medical Clinic Volunteer Application