Whatcom County Health Department (WCHD) Case Contact Investigation (CCI) Volunteer Portal Online Form

2. 

4. The Whatcom County Health Department seeks volunteers to serve as Case Contact Investigators (CCI). CCI volunteers would serve an average of 20 hours per week for six months.

6. First Name*

7. Last Name*

9. Home Phone (Use format xxx-xxx-xxxx)

10. Cell Phone (Use format xxx-xxx-xxxx)

12. Email Address

16. Availability

18. I understand Whatcom County Health Department (WCHD) is seeking a minimum commitment of an average of 20 hours per week for six months from Case Contact Investigation (CCI) volunteers, and I am able and willing to make this commitment.*

    1. I agree
    2. I disagree

19. Currently all Case Contact Investigations are conducted remotely by phone. This helps all involved to minimize the risk of exposure. Do you have access to a private space and a computer with a solid internet connection?*

    1. Yes
    2. No

21. Our Case Contact Investigation teams typically conduct investigations between 8:00am and 4:30pm. Please indicate which day(s) of the week you are available*

    Check all that apply.

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
22. Is there any additional information about your availability you’d like to share with us?

26. Education, Training & Skills

28. You will be required to complete the free Johns Hopkins University online course, COVID-19 Contact Tracing, offered through Coursera
    COVID-19 Contact Tracing

30. Have you completed the free Johns Hopkins University COVID-19 Contact Tracing Course online? (a copy of course completion will be requested prior to interview)*

    1. Yes
    2. No

32. Please describe your interest in being a Case Contact Investigator.*

36. Highest level of eduction completed.*

    1. High School/GED
    2. Associate Degree
    3. Bachelor's Degree
    4. Graduate Degree

38. Are you currently a licensed medical provider in Washington State?*

    1. Yes
    2. No

40. List all licenses currently held.

    Check all that apply:

    1. Certified Medical Assistant (CMA)
    2. Certified Nursing Assistant (CNA)
    3. Doctor/MD
    4. Licensed Practicing Nurse (LPN)
    5. Nurse Practitioner (ARNP)
    6. Physician's Assistant (PA)
    7. Registered Nurse (RN)
    8. Social Worker (MSW) (LSW)
    9. Paramedic (PM), Emergency Medical Technician (EMT), Emergency Medical Responder (EMR), Wilderness First Responder (WFR), Wilderness First Aid (WFA), Outdoor Emergency Care (OEC)
    10. Behavioral Health Specialist
    11. Other
42. If you chose other, please describe other licenses you currently hold.

44. What language(s) are you fluent in?*

    Check all that apply:

    1. English
    2. Punjabi
    3. Russian
    4. Spanish
    5. Other(s)
46. If you chose other, please describe other languages you are fluent in.

48. Is there any additional information you would like to share with us about your training, skills, or licenses?

52. In order to help us coordinate safe working practices, please review the following:

    · I am over 60 years of age.
    · I have chronic lung disease or moderate to severe asthma.
    · I have serious heart disease.
    · I am immunocompromised. including cancer treatment.
    · I am pregnant.
    
    Please check only one box below.

    1. One or more of the above applies to me.
    2. None of the above apply to me.
    3. I choose not to answer.
54. Volunteer Agreement: *

    I hereby certify that the facts set forth in this volunteer application are true and correct to the best of my knowledge. I agree that if the information given in my application or any other materials, or during any interview, is found to be false in any way, it shall be considered sufficient cause for denial of volunteer status.
    
    I understand that Whatcom County Health Department (WCHD) is not obligated to appoint me to a volunteer position and that nothing contained in the volunteer application form is intended to create a contract between WCHD and me. I agree to comply with all policies, rules, regulations and procedures of WCHD, which I understand may change at any time; and I understand that my volunteer status can be terminated with or without cause or notice, at any time, at the option of either me or WCHD.
    
    

    1. I agree.
    2. I disagree
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

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