New AIM Volunteer Screening Form Name* First Last Please rate how comfortable you are working with an individual who is severely handicapped*not comfortablesomewhat comfortablecomfortablevery comfortablecompletely comfortablePlease rate how comfortable you are working with a patient who is critically ill*not comfortablesomewhat comfortablecomfortablevery comfortablecompletely comfortablePlease rate how comfortable you are working with a patients who are connected to machines, pumps, or wires*not comfortablesomewhat comfortablecomfortablevery comfortablecompletely comfortablePlease rate how comfortable you feel handling a situation where someone becomes belligerent*not capablesomewhat capablecapablevery capablecompletely capablePlease rate how comfortable you feel maintaining composure when an individual is erupting emotionally (eg. crying)*not capablesomewhat capablecapablevery capablecompletely capablePlease rate how comfortable you feel maintaining professionalism and excusing yourself from a situation that has caused you to feel uncomfortable*not capablesomewhat capablecapablevery capablecompletely capablePlease indicate how often you will be able to arrive on time and stay for the duration of your shift?*neverrarelysometimesoftenalwaysPlease indicate how often you will be able to comply with AIM volunteer dress code (AIM apron over white shirt or AIM polo shirt, black or khaki full length pants, closed-toed shoes, and volunteer name badge)*neverrarelysometimesoftenalways
