Fill out this application form if you wish to volunteer at Baylor Scott and White Medical Center Grapevine

Baylor Scott & White Medical Center Grapevine - Volunteer Services Application

Personal Information
First Name
Last Name
Home Address
City
State
Zip Code
Home Phone
Mobile Phone
Work phone
Email
Birth Month/Date
Current Employer or School
Occupation

Emergency Contact Information
In case of emergency notify
Relationship to you
Home Phone
Work phone
Mobile Phone

References and Screening
Adult Applicant Non-Relative References
Name
Phone Number
Email
Address
City
State
Zip
Name
Email
Phone Number
Address
City
State
Zip
Have you ever been convicted of, been given probation or deferred adjudication in lieu of sentencing, pled no contest for any offense other than minor traffic violations or are you charged with an unresolved criminal charge? (Are you charged with a crime that has not yet resulted in a plea of guilty, court trial, deferred adjudication or dropping of the charge?)
If yes, please explain
Have you been involved in healthcare legal action in the past four years?
If yes, please explain
Do you currently use nicotine products including, but not limited to, cigarettes, ecigarettes, cigars, pipes, chewing tobacco, nicotine patches or gum?

Background Information
Previous work and/or volunteer experience
Skills
How did you find out about our volunteer program?
Reason for volunteering
Type of service that interests you:
Clerical
Gift Shop
Guest Services
Patient Area
Specialty Programs*
*To be considered for one of our specialty volunteer programs, check all that apply.
I am a:
Former Cardiac Patient
Cancer Survivor
Patient/Family Advisor
Pet Therapy Escort
Retired Nurse

Available Times
Please check the times you would be available for volunteer assignments.
Adult Volunteers
Day(s) Prefered:
Hours Prefered (may vary):
Sunday
Early Morning
Morning
Monday
Afternoon
Tuesday
Evening
Wednesday
Thursday
Friday
Saturday
Once accepted into the volunteer program, I agree to give regular and dependable service to Baylor Scott & White Medical Center - Grapevine.
The application process includes a personal interview, checking of references, submitting to a criminal background check, completing a two-step TB screening, a drug and nicotine screening, and attending general volunteer orientation. Upon acceptance, you will receive training to enable you to efficiently perform your duties as a volunteer. It is expected that volunteers will comply with the hospital and department policies and guidelines.