COVID-19 Vaccine Volunteer Registration

First Name

Last Name

E-Mail Address

Phone Number

Please enter full number including area code. No characters, only digits.

I am in good health

I am over the age of 18

Thank you for your interest but we are unable to proceed with your application at this time.

Volunteer Affiliation

I am a registered WMCHealth Volunteer or active WMCHealth Employee

On Boarding Requirements

If you are not a registered WMCHealth Volunteer or active WMCHealth Employee you will need to complete the following onboarding steps.

1. Consent to a background check. WMCHealth utilizes the NYS Central Register Database Check Form and Criminal Form. You will receive an email from CARCO/CISIVE to complete this step. There is no cost to you for this.

2. Complete a virtual orientation program. Upon completion of this orientation, you will be asked to sign an attestation of completion of orientation, the WMCHealth Code of Conduct and Confidentiality Agreement.

3. Commit to three shifts a week during a 90-day commitment.

Vaccination Protocol

WMCHealth is operating this vaccination site under the direction of the NY State Department of Health, (NYSDOH). As such, guidelines for scheduling volunteers for vaccination will be set forth by NYSDOH. While we understand that many are eager to get vaccinated, we must follow the states direction as they manage the scheduling and supply at each site. It is not necessary to be vaccinated to start as a volunteer. Volunteers are encouraged to make an appointment through additional channels listed on https://am-i-eligible.covid19vaccine.health.ny.gov/

I agree and understand the on boarding requirements and vaccination protocol:

Thank you for your interest but we are unable to proceed with your application at this time.

Preferred Location

Role Preference

Clinical Role

Non-Clinical Support Role

Languages Spoken

May select multiple choices

If other, please specify:

Volunteers are asked to commit to 3-4 shifts a week during a 90-day commitment.

On Boarding Clearance Background Check

License Check

Yes

No

NEO Cleared

Yes

No

Background Cleared

Yes

No

NYSDOH Training Cleared

Yes

No

Date Cleared

Vaccinated

Are they an active volunteer who has completed their 3 shifts?

Yes

No

Is the volunteer vaccinated?

Yes

No

Contact Information