grant permission to Yakima Valley Memorial Hospital Association to verify and
obtain information needed to process my volunteer application. I hereby release all
agencies contacted from
any and all liability of damages for providing the information requested.
Further, I certify that the above information is true and correct to the best
of my knowledge. I understand that misrepresentation or omission of facts is cause for rejection or termination of placement. Placement is contingent upon a satisfactory Criminal History Report. I understand that this application does not create a contract of employment or promise of future employment. I understand that my request to volunteer is voluntary, unpaid, and can be terminated at any time at the option of either the agency or myself. I understand that my ID badge is my responsibility. I will not loan it to anyone, will report immediately if lost or stolen, and will return it when I am no longer a volunteer for YVM.
My typed name below verifies that I have read and
agree to comply with the above Confidentiality, HIPAA, and Acceptable Use
Policies. I understand my responsibility in protecting these rights. My typed
name below shall have the same force and effect as my written signature.