Children's Medical Center Dallas Adult Volunteer Application

Contact Information

As a reminder, we will use email as our primary method of contact. Please make sure to provide a current email address.

Title

* First Name

MI

* Last Name

Preferred Name

* Home Address

* City

State (as combo)

* Zip Code

Preferred Contact Phone

* Phone (Preferred phone)

* E-mail address

Demographic & Personal Information

* Date of Birth

Extended gender

Additional languages

T-shirt Size

Marital Status

Education, Employment, & Volunteer Experience

Education

School/University

Are you currently enrolled as a college student? If so, are you pursuing a healthcare related career? If yes, please explain.

Work Status

Employer

Position

Title

Volunteer Experience

Background Check & Felony Conviction

Children's Health requires every volunteer applicant to submit to a background check prior to service and on an annual basis.
Applicants seeking to perform court mandated service will not be considered.

Have you been convicted of a felony or misdemeanor (including pleading guilty and no contest)?

Availability

Please choose the program you would like to apply to.

Please note that the minimum expectation of volunteer service is 50 hours over the course of six consecutive months.

Dallas Adult Volunteer Program Options:

Daytime Program - One consistent shift per week Monday-Friday 9 am-1 pm or 1 pm-5 pm.

Evening Program- One consistent shift per week Monday- Thursday from 5:30pm-8:30 pm or Friday from 5pm- 7:30pm.

Weekend Program- One consistent shift either every 1st and 3rd Saturday or Sunday or every 2nd and 4th Saturday or Sunday. Shifts are from 9am-1pm, 1-5pm, or 5-7pm.

Availability

Service Leagues and Groups

Are you an active member of any of the following service leagues or groups?

Service Leagues and Groups

Personal Loss

* Have you had an experience or personal loss within the last 12 months that would impact your ability to serve in certain areas of the hospital?If you have lost a loved one within the past 12 months, please consider sharing. We have found volunteering can be difficult after a recent loss and want each volunteer to have a successful experience.

References

Please provide contact information for two references who have known you for a minimum of 2 years.

Please note references may not be family members.

Reference #1

* First Name

Middle Name

* Last Name

Nickname

* Preferred Contact phone

Work phone

Cell phone

Email address

Relationship

Reference #2

* First Name

Middle Name

* Last Name

Nickname

* Preferred Contact phone

Work phone

Cell phone

Email address

Relationship

Emergency Contact Information

Please list name and phone number(s) of an emergency contact.

* Contact name

* Relationship

* Phone (Preferred phone)

Connection to Children's Health

* Please tell us about any personal connections you have with Children's Health or its employees. If you have family members or friends who are employees or volunteers, please list their name(s) and department of service.

Application Agreement

I understand adult volunteers must be at least 18 years of age and not enrolled in high school, agree to serve in a regular placement over six consecutive months and provide all necessary health information prior to volunteering.

I affirm that the information provided in this application is true and complete. Falsification of any information can result in immediate dismissal from the Volunteer Services Department.

I hereby give my permission and authorize representatives of Children's Health to investigate any or all of the statements I have made in this application.

I understand that this application does not guarantee avolunteer placement at Children's Health.

I further understand that as a volunteer, I may not accept payment for my service and that I will incur the cost of the volunteer uniform and transportation.

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E-Signature