Welcome Irving Health Care Volunteers

Fill out this application form if you wish to volunteer at Baylor Scott & White Medical Center at Irving.

Baylor Medical Center at Irving- Volunteer Services Application

Personal Information
First Name
Last Name
Home Address
City
State
Zip Code
Home Phone
Mobile Phone
Work phone
Email
Current Employer or School
Hispanic
Bi-Racial
Caucasion
African-American
Asian
Other
Ethnicity:

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

References and Screening
Adult References (no relatives):
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
Are you a Veteran of the US Military? If so, please provide branch, highest rank and years of service
Branch
Rank
Years of Service
Previous work and/or volunteer experience
Language(s) spoken with proficiency other than English
Skills
Hobbies
How did you find out about our volunteer program?
Reason for volunteering
Type of service that interests you:
Patient Area
Guest Services
Clerical
Specialty Programs*
*To be considered for one of our specialty volunteer programs, check all that apply.
I am a:
Cancer Survivor
Pet Therapy Escort
Retired Nurse
Bariatrics
Other
Heart Patient

Available Times
Please check the times you would be available for volunteer assignments.
Day(s) Prefered:
Hours Prefered (may vary):
Early Morning
Sunday
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 Medical Center at Irving.
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 toefficiently perform your duties as a volunteer. It is expected that volunteers will comply with the hospital and department policies and guidelines.