Volunteer Name:
Volunteer Age:
Volunteer Grade:
Junior Volunteer Application
(Ages 14 - 21)
Medical Center Alliance
3101 North Tarrant Parkway
Fort Worth, TX 76177
Phone: 817-639-1000
Fax: 817-639-1727
If you are unable to drop off application at the front desk, you are welcome to fax it to the number above.
JuniorVolunteerGuidelines
ThankyouforyourinterestinbecomingaJuniorVolunteeratMedical Center Alliance.
PleasecarefullyreadtheguidelinesandrulesthatapplytoJuniorVolunteersandhaveaparentorguardianreadthemalso.
I.REQUIREMENTSJr. Volunteer Ages:14–21
Forms: AllApplication FormsandotherrequiredformsmustbecompletedbeforeyouwillbeconsideredforaJuniorVolunteerposition.TheFollowingitemsarerequired:
- CopyofcurrentReportCard(mustmaintaina"B"averageorhigher)
- Copyofcurrentup-to-dateimmunizationrecord
- 2lettersofrecommendationfromsomeoneotherthanafamilyisrequired.
Screening:Everyvolunteerwillhavetopassabackgroundcheck,drugscreenand TBskintestbeforetheycanstart.
Interview:Youwill meetwiththe Volunteer Coordinator or Employee Health NursetodiscusstheVolunteerGuidelines,andrequirementsafteryouhavecompletedallnecessarypaperwork.
Service:Werequireaminimumof4hours per week per semester ofserviceasaJuniorVolunteer.ThisusuallybeginsinJuneandendsinSeptemberofeachyearbutmaybeextendedonanindividualbyindividualcase.
Medical: AnnualPPD(Tuberculosisscreening)forallVolunteersisrequiredwithin30daysofyourstartdate.VolunteersmayhavethesetestsatMedical Center Allianceatnocharge. Parental/Guardian consentforPPDisrequired.MedicalrequirementsmustbecompletedBEFOREservicebegins.
Training: VolunteerOrientationattendanceisrequiredbeforeyoumaystartyourservice.Youwillbeinformed ofthedateandtimeoftheorientationclassafteryouareacceptedtotheprogram.
II.ATTENDANCEANDABSENCES
JuniorVolunteersbecomeanintegralpartoftheirdepartmentandtheHospitalstaff reliesontheirpresenceasscheduled.WeunderstandthatallVolunteersmaygetsick,takevacations orhaveunavoidableconflicts(exams!)ontheirregularvolunteerday.AmessagemaybeleftontheVolunteerCoordinators phoneat817-639-1937or817-688-5858 whenyouarenotabletofulfillyourdutiesforthatday.
VolunteerswhohavetakenanextendedleaveofabsencemustcontacttheVolunteer Coordinatorbeforereturningtoservice. Similarly, pleasenotifytheVolunteerCoordinatorifyouareresigningfromtheVolunteerServiceandreturnyourIDbadge.
III.UNIFORMANDDRESSCODE
EachJuniorVolunteerisrequiredtowearthecorrectapprovedJuniorVolunteeruniformatalltimeswhileonduty.The JuniorVolunteerrequireduniformisthefollowing: MaleandFemaleJuniorVolunteerUniformsarethesame.
- Shirts-WHITEcollared short or long-sleeve shirt.
- Pants-Khakidressslacks.Nohiphugger,lowrider,orbaggypantsallowed.
- Donotuseperfumeorotherscentedproductsasitmaycauseallergicreactionsinsomepatients atanytimewhileonduty.
IV.VOLUNTEER ASSIGNMENTANDSCHEDULES
EveryJuniorVolunteerisrequiredtocommit toanassignmentofone4hour shiftper weekforaminimumofone semestercommitmentperiod.WeekendshiftsareavailableIFAPPROVED by Volunteer Coordinator.
YouwillbegivenoneormoreregularvolunteerassignmentsbasedupontheneedsoftheHospital. Everyeffortwillbemadetotakeintoaccountyourspecialinterestsandskills.
Available shifts asfollows:
- 8:00a.m.–12:00p.m.Monday-Friday
- 1:00 a.m. –5:00 p.m. Monday-Friday
Jr.Volunteer’sdutiesincludebutarenotlimitedto:
- Escort families,visitorstovariousareasasneeded.
- MakeHappy Cart roundsonallfloorsseveraltimesduringyourshift.
- Transportspecimens,supplies,etc.tolabandotherdepartments.
- Runerrandsasrequestedbyunitstaff
- Assistpatientwithmeals - open containers,setup trays,etc.
- Helptransportdischargedpatientsoffunit.
- Keeppublicareastidy,uncluttered,readingmaterialsprovided.
- Anyotherdutiesasassignedby Director or Supervisor.
WeexpectourJuniorVolunteerstocontinuetheirtraditionofmatureandresponsiblebehavioratalltimes.ThisincludesawillingnesstoacceptsupervisionandtofollowHospitalrules.
V.SIGN-INPROCEDURE
Whenyouarriveforyourshift,signinatthefront desklocatedonthe1stfloor. Contact the nursing supervisor at *91888 and have them sign you in/out. Youareresponsible forkeepingtrackofthehoursyouwork.PleasedonotbringvaluablesorcashtotheHospitalexceptforwhat youabsolutelyneed.
VI.MEALBREAKS
YourVolunteerPhotoIDentitlesyouto onefreemealinthecafeteriawhileonduty.DonotuseyourVolunteerPhotoIDtopurchaseitemsfromthecafeteriaforanyoneotherthanyourself.
VII.PARKING
Volunteersarenot allowed to park in patient/visitor parking directly in front of Medical Center Alliance.
I, onthisday,havereadtheguidelinestotheVolunteerProgram. Iherebyagreetoallthetermsandconditionstothisprogram.
Signature of Jr. Volunteer______
Astheparent/legalguardianofthisjuniorvolunteer,Ihavereviewedtheserequirementsandgivepermissionforthemtoparticipate.
Name: ______
Signature: ______Date: ______
Inordertoapplyforthisvolunteeropportunity,youmustreadandagreetothetermsaswellascompleteandreturntheattachedformstoMedical Center Alliance front desk.
Forquestionsontheprocess,pleasecontactAlex Roberson,
JR.VOLUNTEERAPPLICATION
Pleaseprintclearlyandanswerallquestions,which applytoyou:
LastNameFirstNameMiddleName
HomeAddressCityStateZipCode
HomePhoneCellPhone
Email Address: ______
Do you work? Y or N If yes, where do you work? Maywecallyouatwork?Duringwhatdaysandhours? StudentGradeLevel ______
What school do you attend? ______
DaysAvailable: Monday / Tuesday / Wednesday / Thursday / FridayTimeAvailable:Morning or / Afternoon
VolunteerCategory:Junior(14to21yearsofage)
VolunteerExperience
Pleaselistanyvolunteerexperience,includingschoolandchurchvolunteeractivities:Agency City.State Dates Duties
Training,Education,Certification
Pleaselistanyspecialtraining,licenses,certificationsordegrees:
Specialinterests
Pleaselistyourhobbies,skillsorareasofspecialinterest:
References
Pleaselisttwoadultpersonalreferences,otherthanrelatives,whomyouhaveknownforatleasttwoyears:
NameAddressPhoneRelationshipYearsKnown
CONFIDENTIALMEDICALDISCLOSURE
Thisformisnot tobekeptinthevolunteerfile.ItistobeforwardedtoEmployeeHealthNurseimmediatelyuponcompletion.
Name: ______Date: ______
Address: ______
Contact Number: ______
Emergency Contact(s)
Name: ______Relationship to you: ______
Address: ______
Phone Number: ______
Name: ______Relationship to you: ______
Address: ______
Phone Number: ______
Please list any medical conditions you have:
______
______
I certify that the above information is true and complete to the best of my knowledge at the time of application to become a volunteer at Medical Center Alliance. I understand that it is my responsibility to update this information with the Employee Health Nurse or Volunteer Coordinator if any changes occur. I hereby give Medical Center Alliance permission to release pertinent information in the event of a medical emergency.
Signature: ______Date: ______