Junior Volunteer Application (Ages 14-18)

Transcription

1 Volunteer Name: Volunteer Age: Volunteer Grade: Junior Volunteer Application (Ages 14-18) Medical Center Alliance 3101 North Tarrant Parkway Fort Worth, TX Phone: Fax: If you are unable to drop off application at the front desk, you are welcome to fax it to the number above.

2 Junior Volunteer Guidelines Thank you for your interest in becoming a Junior Volunteer at Medical Center Alliance. Please carefully read the guidelines and rules that apply to Junior Volunteers and have a parent or guardian read them also. I. REQUIREMENTS Jr. Volunteer Ages: Forms: All Application Forms and other required forms must be completed before you will be considered for a Junior Volunteer position. The Following items are required: Copy of current Report Card (must maintain a "B" average or higher) Copy of current up-to-date immunization record 2 letters of recommendation from someone other than a family is required. Screening: Every volunteer will have to pass a background check, drug screen and TB skin test before they can start. Interview: You will meet with the Volunteer Coordinator or Employee Health Nurse to discuss the Volunteer Guidelines, and requirements after you have completed all necessary paperwork. Service: We require a minimum of 4 hours per week per semester of service as a Junior Volunteer. This usually begins in June and ends in September of each year but may be extended on an individual by individual case. Medical: Annual PPD (Tuberculosis screening) for all Volunteers is required within 30 days of your start date. Volunteers may have these tests at Medical Center Alliance at no charge. Parental/Guardian consent for PPD is required. Medical requirements must be completed BEFORE service begins. Training: Volunteer Orientation attendance is required before you may start your service. You will be informed of the date and time of the orientation class after you are accepted to the program. II. ATTENDANCE AND ABSENCES Junior Volunteers become an integral part of their department and the Hospital staff relies on their presence as scheduled. We understand that all Volunteers may get sick, take vacations or have unavoidable conflicts (exams!) on their regular volunteer day. A message may be left on the Volunteer Coordinators phone at or when you are not able to fulfill your duties for that day. Volunteers who have taken an extended leave of absence must contact the Volunteer Coordinator before returning to service. Similarly, please notify the Volunteer Coordinator if you are resigning from the Volunteer Service and return your ID badge.

3 III. UNIFORM AND DRESS CODE Each Junior Volunteer is required to wear the correct approved Junior Volunteer uniform at all times while on duty. The Junior Volunteer required uniform is the following: Male and Female Junior Volunteer Uniforms are the same. Shirts- WHITE collared short or long-sleeve shirt. Pants - Khaki dress slacks. No hip hugger, low rider, or baggy pants allowed. Do not use perfume or other scented products as it may cause allergic reactions in some patients at any time while on duty. IV. VOLUNTEER ASSIGNMENT AND SCHEDULES Every Junior Volunteer is required to commit to an assignment of one 4 hour shift per week for a minimum of one semester commitment period. Weekend shifts are available IF APPROVED by Volunteer Coordinator. You will be given one or more regular volunteer assignments based upon the needs of the Hospital. Every effort will be made to take into account your special interests and skills. Available shifts as follows: 8:00 a.m. 12:00 p.m. Monday-Friday 1:00 a.m. 5:00 p.m. Monday-Friday Jr.Volunteer s duties include but are not limited to: Escort families, visitors to various areas as needed. Make Happy Cart rounds on all floors several times during your shift. Transport specimens, supplies, etc. to lab and other departments. Run errands as requested by unit staff Assist patient with meals - open containers, set up trays, etc. Help transport discharged patients off unit. Keep public areas tidy, uncluttered, reading materials provided. Any other duties as assigned by Director or Supervisor. We expect our Junior Volunteers to continue their tradition of mature and responsible behavior at all times. This includes a willingness to accept supervision and to follow Hospital rules. V. SIGN-IN PROCEDURE When you arrive for your shift, sign in at the front desk located on the 1st floor. Contact the nursing supervisor at *91888 and have them sign you in/out. You are responsible for keeping track of the hours you work. Please do not bring valuables or cash to the Hospital except for what you absolutely need. VI. MEAL BREAKS Your Volunteer Photo ID entitles you to one free meal in the cafeteria while on duty. Do not use your Volunteer Photo ID to purchase items from the cafeteria for anyone other than yourself. VII. PARKING Volunteers are not allowed to park in patient/visitor parking directly in front of Medical Center Alliance.

4 I, on this day, have read the guidelines to the Volunteer Program. I hereby agree to all the terms and conditions to this program. Signature of Jr. Volunteer As the parent/ legal guardian of this junior volunteer, I have reviewed these requirements and give permission for them to participate. Name: Signature: Date: In order to apply for this volunteer opportunity, you must read and agree to the terms as well as complete and return the attached forms to Medical Center Alliance front desk. For questions on the process, please contact Alex Roberson, the volunteer coordinator at or robert.roberson@hcahealthcare.com

5 JR. VOLUNTEER APPLICATION Please print clearly and answer all questions, which apply to you: Last Name First Name Middle Name Home Address City State Zip Code Home Phone Cell Phone Address: Do you work? Y or N If yes, where do you work? May we call you at work? During what days and hours? Student Grade Level What school do you attend? Days Available: Monday Tuesday Wednesday Thursday Friday Time Available: Morning or Afternoon Volunteer Category: Junior (14 to 21 years of age) Volunteer Experience Please list any volunteer experience, including school and church volunteer activities: Agency City. State Dates Duties Training, Education, Certification Please list any special training, licenses, certifications or degrees: Special interests Please list your hobbies, skills or areas of special interest: References Please list two adult personal references, other than relatives, whom you have known for at least two years: Name Address Phone Relationship Years Known

6 CONFIDENTIAL MEDICAL DISCLOSURE This form is not to be kept in the volunteer file. It is to be forwarded to Employee Health Nurse immediately upon completion. 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: