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?)
Yes
No
If yes, please explain
Have you been involved in healthcare legal action in the past four years?
Yes
No
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?
Yes
No
Background Information
Previous work and/or volunteer experience
Skills
Administration/Office
Artist
Audio/Visual
Child Care
Computer - Data entry
Computer - IT general
Construction - Carpentry
Construction - Electrical
Construction - General
Construction - Painting
Construction - Plumbing
Custodial
Event Planning
Food Services - Delivery
Food Services - Preparation
Fundraising
Gardening
Grant Writing
Graphic Design
Language/Translator
Law Enforcement
Legal
Library
Marketing/Communications
Medical - Doctor/Physician
Medical - First Aid
Medical - General
Medical - Nursing
Musician
Photography
Political/Government
Public Relations
Public Speaking
Sales/Cashier
Sports - Coaching
Sports - Official
Transportation - Driver (bus/van)
Transportation - Driver (car)
Transportation - Emergency
Transportation - Moving
Transportation - Parking
Video Production
Writing/Reporting
How did you find out about our volunteer program?
n/a
Billboard
Church
Employer
Friend
Newspaper
Other
School
TV/Radio
Walk-up
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
I am available to volunteer for one 4-hour shift per week for a minimum of one year.
YES
NO
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.