Volunteer Application

Biographical Information
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Education and Employment
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Volunteer Experience & Interests
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Personal References
Please list three personal references not related to you (professional, volunteer supervisors, co-workers). By signing below, you authorize Bluegrass Care Navigators to contact these people to obtain personal references.
Reference #1
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Reference #2
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Reference #3
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Emergency Contact
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Other Requirements to Volunteer:
Our agency requires mandatory influenza vaccinations. We will make exceptions for medical reasons with documentation from the appropriate source. Those who do not wish to take the flu vaccine can still volunteer, but must go inactive during the flu season (typically Nov. 1 - March 31). In addition, patient care volunteers (those who work in patient homes, nursing homes or our inpatient facilities) must have a two-part TB Skin Test to start as a volunteer and complete an annual TB test to remain active (these tests are provided onsite).
Thank you for submitting your application to become a Bluegrass Care Navigators volunteer. Completing this application does not guarantee placement, but we will be in touch soon to inform you of the next steps in our process.
By signing below, you are verifying that all of the information provided in this application is, to your knowledge, true and accurate.