Welcome to St. Joseph Mercy Ann Arbor and Livingston Volunteer Services.

Farming Volunteer

Application date
Personal Information
First Name
Last Name
Address
City
State
Mobile
Zip/postal
E-mail
DOB
Gender
Emergency Contact
Phone Number
Relationship name
Have you ever volunteered, been an employee or student intern/job shadow with the health system?
Yes
No
Are you currently a St. Joe's employee?
Below are listed volunteer tasks. Please check all that interest you
Farm Work
Ground care
Education
Harvesting
Special Event Staff
Helping with the Farmer's Market
Weeding
Watering
Planting
Event Planning
What other interests and skills would you like to share?
Do you have any experience with farming and gardening? If yes, please give a short description
Do you have any physical limitations that we should be aware of?
Avaliability
What is your anticipated frequency and duration of volunteering? (Ex: one time a week for a month)
What days and times of the week are you avaliable?
Have you ever been convicted of anything other than a minor traffic citation, or are there felony charges pending against you?
Yes
No
If yes, please list dates, places, charges and dispostion of all convictions:
Believing that Saint Joseph Mercy Health System (SJMHS) has a need for my services as a volunteer, I agree:
1. I voluntary offer my services with a clear understanding there will be no momentary compensations and that volunteering does not lead to employment.
2. To hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, families, physicians, or personal. I agree that I will not seek confidential information in regard to a patient or SJMHS personal.
3. That I will commit to the minimum requirements for months of volunteer service for the program I am participating in. I will adhere to the agreed upon schedule which would involve notifying areas in case of absences.
4. That if I accept a volunteer position, I will have a duty to be familiar with SJMHS' rules, standards, and policies as they now exist or as they may be modified, added to, or abolished in the future. I have reviewed and agree to comply with these rules, standards, and policies.
5. To wear the designated volunteer uniform and ID at all times while volunteering for SJMHS and to return the uniform and ID badge when I am no longer an SJMHS volunteer.
6. To give a minimum of two weeks notice to the volunteer department when I will be terminating my volunteer service.
I certify that the answers given by me to the foregoing questions are true and without omissions. Misrepresentation of facts constitutes separation from Volunteer Services. I agree to abide by all Saint Joseph Mercy Health System rules and regulations. It is further understood that the Volunteer Services Department is not obligated to provide a placement, nor am I obligated to accept the position offered.
Applicant Signature:
Date:
Date:
Parent/Guardian Signature:
(Minors under 18)