JHH Preplaced Volunteer Application

Preplaced Volunteer Application - The Johns Hopkins Hospital

Personal Information

* Legal First Name

* Legal Last Name

Chosen Name (Optional)

Are you a current Johns Hopkins Medicine (Health System, Community Physicians, Hospital, University, SOM, etc.) employee?

* Home Address

* City

State

* Zip Code

* Phone Number (Mobile)

Phone Number (Home)

* E-mail Address

* DOB

Primary Language

Additional language(s): select all that apply

Employment Information

Please select the entity you work for

Howard County General Hospital

Johns Hopkins All Children's Hospital

Johns Hopkins Bayview Medical Center

Johns Hopkins Community Physicians

Johns Hopkins Health System

Johns Hopkins Home Care Group

Johns Hopkins Medicine International

Johns Hopkins Surgery Center Series

Johns Hopkins University

Johns Hopkins University School of Medicine

Sibley Memorial Hospital

Suburban Hospital

The Johns Hopkins Hospital

Current Department

Current Position

Supervisor's Name

Supervisor's Email

Please only complete if you have an authorized JHED ID (e.g. jdoe173@jh.edu). Please leave blank if you DO NOT have an authorized JHED ID. 

Emergency Contact

* Contact Name

* Relationship

* Phone Number

Education

Highest Grade Level Completed

Employer's Name/School's Name

Occupation/Academic Major

Preplaced Department Information

The Johns Hopkins Hospital's Department of Volunteer Services no longer processes volunteers involved in clinical research and research laboratories. Johns Hopkins University (JHU) student volunteers can be processed through the school of medicine's Office of the Registrar. All other research volunteer requests should go through JHU Human Resources. We apologize for the inconvenience.

Preplaced Department Name (Please select from the drop down menu. If you DO NOT  see your department please select OTHER.)

If you selected 'Other' please specify

* Volunteer Supervisor Name

* Volunteer Supervisor Email

COVID-19 Information

To continue to protect the health and safety of our patients, our workforce and the communities we serve, Johns Hopkins Medicine is mandating that all volunteers be fully vaccinated prior to coming on site. The CDC defines an individual as "fully vaccinated" when two weeks have passed since receiving the second shot of the Pfizer or Moderna vaccine, or two weeks after the single-dose Johnson & Johnson vaccine.

Have you received your COVID-19 vaccination?

If applicable, please upload supporting documentation of your COVID-19 vaccination using the 'Choose File' button below. The documentation must meet the following criteria: Full name is present on vaccine documentation All dates of vaccine are legible All pages are present Documentation is readable If pharmacy receipt the vaccine must clearly be listed If the document is in a language other than English, it must include an English translation The vaccine indicated on the document is an acceptable vaccine per JH guidelines

Final Steps

* I certify all information is true and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest. I release the agency from any liability whatsoever for supplying such information.