Bayview Preplaced Volunteer Application

Please complete this Johns Hopkins Bayview Preplaced Volunteer application and submit the required forms below.

Please enter your e-mail address and create a password to get started. Your Password should be between 8-20 characters in length, contain both upper and lower case, and include at least one number.

New User Details

User ID

User ID (verify)

Password

Password (verify)

Department of Volunteer Services

Bayview Preplaced Volunteers

Required Forms

1. Medical Clearance Form must be completed and approved by Occupational Health. Please include name and date of birth only on the formand submit via email or in person:

Click here to download the Medical Information Clearance Form for OHS

2. Occupational Health Demographic Form must be completed and submitted via email or in person:

Click here to download the OHS Demographics Form

To continue to protect the health and safety of our patients, our workforce, and the community 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 past since receiving the second shot of the Pfizer or Moderna vaccine, or two weeks after the single dose Johnson & Johnson vaccine.

Personal Information

* First Name

* Last Name

* DOB

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

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.

* Home Address

* City

State

* Zip Code

* Phone (Mobile)

Phone (Home)

* E-mail address

Primary Language

Additional language(s): select all that apply

Emergency Contact

* Contact name

* Relationship

* Phone

Education

Highest Grade Level Completed

Employer's Name/School's Name

Occupation/Academic Major

Preplaced Department

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

Other

* Bayview Preplaced Supervisor Name

* Bayview Supervisor's Email

Final Steps

1. Please download and read the Connect Partner & Reflect document:

Connect, Partner & Reflect

2. Please download and read the Infection Control document:

Infection Control

* I have read the preceding infection control and connect, partner & reflect forms.

3. Confidentiality and Consent: Download and read the Confidentiality Statement. When you are finished, sign and date below to indicate that you read and understand the document.

Click here to download the Confidentiality Statement

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Confidentiality Signature

* Effective date

* 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.