Registration: Bloodworks Northwest

If you have already registered for access to our online scheduling system and you have already received your welcome email message with your temporary password, please sign in using that password. 

If you have not completed this form, thank you for taking a moment to complete and submit the following details.


* required field
APPLICANT INFORMATION
 

ADDITIONAL INFORMATION
Ok to text message?
 Yes  No
* Date of Birth - Note you must be at least 14 years of age to volunteer. If you are under the age of 18 you will be asked to provide parental/guardian permission at the end of this application.

Emergency Contact Information
* Emergency Contact Name
* Emergency Phone Number
Emergency Contact Email
* Emergency Contact Relationship

Please help us learn more about you. Which best describes your current status:
Are you in school?
 Yes  No
If yes, what is the name of your school/university?
Are you retired?
 Yes  No
Former Occupation
Former Employer
Are you employed?
 Yes  No
Occupation
Employer

More about you
How often are you interested in volunteering?
1 time a week
2 times a month
1 time a month
In general, what days and times are you available to volunteer?
Please indicate all volunteer positions that interest you:
Greeting and registering blood donors
Monitoring donors in the canteen and serving refreshments
Assisting with office duties: Filling mailing etc.
Calling donors to remind them of their appointment
Organizing a blood drive
Driving blood and supplies between blood center locations (Seattle metro area primarily but could include riding the ferry)
Setting up blood drive signage in your community (must be able to lift 20lbs)
Assisting with events
Entering information into a database and other general computer tasks
Other specific skills and abilities that I can offer - please describe (e.g. fundraising, marketing, accounting, IT, graphic design, etc.)
At which of our locations are you interested in volunteering?
Bellingham
Eugene
Everett
Lynnwood
Transportation
North Seattle
Bellevue
Central Seattle
Tukwila
Federal Way
Silverdale
Olympia
Portland
Vancouver
Are you interested in volunteering at blood drives in your community?
 Yes  No
If yes, approximately how many miles from home are you willing to travel?

Volunteer Hour Information
Are your volunteer hours required for school?
 Yes  No
If YES, please provide your school name, # of hours and date they need to be completed by

Are your volunteer hours court ordered?
 Yes  No
If YES, please provide the name and contact number of the court or agency requiring the service, # of hours and date they need to be completed by
Are your volunteer hours required for some other reason?
 Yes  No
If YES, please let us know why, # of hours and date they need to be completed by

Additional Questions
Please tell us if you need any reasonable accommodations to perform volunteer tasks
Why did you choose Bloodworks as a place to volunteer?
Please describe the qualities and skills you bring to your volunteer work.
Please tell us a bit about your hobbies, volunteering, education, or anything else you'd like us to know.
Who referred you to Bloodworks, or how did you learn about our volunteer program?
* Have you been convicted of a misdemeanor or felony?
 Yes  No
If YES, please explain. A conviction does not automatically preclude you from volunteering.

Personal Reference
Reference Name
Reference Phone
Reference Email
Reference Relationship

Acknowledgement

Background Check – Authorization, Waiver and Full Release

 

Authorization to conduct a full background check and obtain any and all records and other information for volunteer application purposes/serving as a volunteer and full release from liability of all parties for any and all claims, of any nature whatsoever, for volunteer application purposes and performing volunteer services for Bloodworks Northwest (“Bloodworks”) whether on or off Bloodworks work areas or premises.

 

To the applicant: This form must be filled-out completely, truthfully and with absolute no omissions. Leave no blanks. Direct any questions to a Volunteer Services Supervisor.

 

READ All INFORMATION CAREFULLY BEFORE SIGNING

I hereby authorize Bloodworks to fully investigate my background and to contact any third party and/or utilize the services of an outside agency or other third party to conduct a complete background investigation on me that will include information, documents and statements of both public and private records, as well as civil and criminal court records as well as records from local, state and federal administrative agencies. I certify under penalty of perjury that the statements and information I have provided in my application and at any time during the process of becoming a volunteer at Bloodworks is true, accurate and complete. I understand that if I am accepted as a volunteer, any false, incomplete, misleading or inaccurate statement or omission of information on my application or that I provide Bloodworks at any time during the application process or at any time while I serve as a volunteer may result in my dismissal and/or disqualification for volunteer opportunities regardless of when discovered. I further understand that this application and any other statements by any representative of Bloodworks is not intended to be an agreement, promise or contract of employment or volunteer involvement, nor does this application create an obligation in any way to provide me with volunteer opportunities or require that I volunteer at any time at Bloodworks. By signing hereto, I fully waive any and all claims of any nature whatsoever against Bloodworks, its employees, agents, supervisors, managers, directors and assigns; and, any third party or other entity acting on Bloodworks behalf that provides Bloodworks information about me; and any outside agency utilized by Bloodworks or anyone else to obtain and communicate any information about me of any nature whatsoever. In addition, I agree to hold harmless Bloodworks, its employees, agents, assigns, supervisors, managers, directors and any third party that obtains, communicates or provides Bloodworks any information, of any nature whatsoever, about me; and any outside agency or other third party utilized by Bloodworks to obtain, communicate or provide information about me. A photocopy of this authorization shall be accepted as an original by myself, Bloodworks and all other third parties.

* I have read the above carefully and understand that this is a full and complete waiver of any claims, of any nature whatsoever, that I may have against Bloodworks or any of the parties described above. Checking the "Yes" box serves to verify my identity as the person submitting this application, and waiving claims.
 Yes
Applicants who are 14-17 years old must provide a Parent/Guardian Authorization, select the link provided here to download the document and bring it with you once your volunteer orientation is scheduled.
I am 14 years old. IF YES, PRINT PARENTAL/GUARDIAN AUTHORIZATION AND PROVIDE AT VOLUNTEER ORIENTATION
Refer to: Parental / Guardian Authorization Waiver
 Yes
Additional Information needed to conduct the background check: Other names used (i.e. maiden name, aliases, nicknames)
Gender



Thank you for applying to volunteer with Bloodworks Northwest! Together we’re bettering our community, drop by drop.


 
 
Seattle, Washington 98104
206-292-6500
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