Welcome to the Volunteer Application Portal for Medical City Dallas, Medical City Children's Hospital and Medical City Heart & Spine Hospital.

ALL ADULT and SENIOR APPLICANTS MUST BE 18 YEARS OF AGE OR OLDER, NO EXCEPTIONS



Please complete all areas of this application to the best of your ability. If you are selected for our program, Medical City Dallas requires a background check release (with a social security number provided) as well as a copy of current immunization records. Medical City Dallas will conduct an initial health screen (including a blood draw) at no charge to the applicant, unless the applicant does not comply with TB testing guidelines.

Medical City Dallas requires the following minimum commitment:

ADULT VOLUNTEERS (age 18; non-students) - 12-month commitment to one 4-hour shift per week

SENIOR VOLUNTEERS (age 18; college students) - commitment to one 4-hour shift per week, every week for the entire semester
- Spring Semester (January 16 - May 31)
- Summer Semester (June 1 - August 31)
- Fall Semester (September 1 - January 15)


*** If you cannot meet the expectation of this required commitment, please do not apply. Medical City Dallas will not provide verification of hours of volunteer service for those who do not fulfill this required commitment. ***

Volunteer Application - ADULT & SENIOR (Ages 18 and up)

VOLUNTEER INFORMATION
First name
Middle name
Last name
DOB (MM/DD/YYYY)
Gender
Volunteer Source
Home address
Personal E-mail
Home address (line 2)
City
State
Zip / Postal Code
Home phone (nnn-nnn-nnnn)
Mobile phone (nnn-nnn-nnnn)
Highest level of education completed
Current school/institution
Current student
Current major/course of study
Expected graduation date
Location of Interest
Area of Interest (select 'General' if none of the other groups apply to you)
Church Affiliation for Eucharistic Ministers ONLY (all other applicants: please select N/A)
Volunteer Commitment Acknowledgement - Please check the box to CONFIRM that you will meet the mandatory volunteer commitment of a minimum of one 4 hour shift (as assigned) per week as outlined above.
REFERENCES
Reference 1
Name
Relationship
Organization
Phone (nnn-nnn-nnnn)
Address
E-mail
City
State
Zip / Postal Code
Reference 2
Name
Relationship
Organization
Phone (nnn-nnn-nnnn)
Address
E-mail
City
State
Zip / Postal Code
EMERGENCY CONTACT
Contact name
E-mail
Address Line 1
Address Line 2
City
State
Zip / Postal Code
Home phone
Work phone
Mobile (nnn-nnn-nnnn)
AVAILABILITY
Morning
Afternoon
(8:30am-12:30pm)
(12:30pm-4:30pm)
M (am)
M (pm)
T (am)
T (pm)
W (am)
W (pm)
Th (am)
Th (pm)
F (am)
F (pm)
PLACEMENT QUESTIONS
Why do you want to volunteer?
What do you enjoy most about being a volunteer?
Do you have any specific interests that you would like to utilize as a volunteer?
Indicate any skills you have
If so, select another language you can speak?

Your consent for a criminal background check is required along with your social security number. You will give your social security number in person; please do not include it anywhere in this application. Thank you.

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AUTHORIZATION FOR RELEASE OF INFORMATION TO: Medical City Dallas


Pursuant to the requirements of the Fair Credit Reporting Act, notice is given that a consumer report may be made in connection with your application for volunteering at Medical City Dallas.The report may include, but is not limited to, information concerning past work history, criminal record(s), plea bargains, deferred adjudications, exclusions from Medicare/Medicaid, GSA sanctions, educational achievement, professional licensure(s) or certification(s), driving record, credit history and past residences. This information will be used, in part, to determine your eligibility for employment or volunteer position within this organization. As long as you remain a volunteer here, the criminal history records check may be repeated at any time.

If you are denied employment or volunteer position, either wholly or partly, because of information contained in this consumer report, a disclosure will be made to you of the name and address of the consumer reporting agency making such report.

I understand the above notice and realize that my offer of a volunteer position is contingent on successful completion of references, license and academic verification, pre-placement health screening for essential functions of the job and the drug screen.

 

I was recently interviewed and/or am applying for a volunteer position by Medical City Dallas. As part of my volunteer position or potential volunteer position, I authorize you to release my academic records, employment records, and other related background information to Group One services on behalf of Medical City Dallas. I hereby state that all information given by me on this form is true in all respects. I agree that if I am accepted to a volunteer position and the information is found to be false in any respect, I will be subject to dismissal at any time.

 

I hereby release any individual or entity, including record custodians from all liability for damages of any kind or nature that may at any time result to me because of compliance, or any attempt to comply, with the objectives of this authorization.

 

I certify that the information provided by me in my volunteer application is true, correct, and complete to the best of my knowledge. I understand that my placement as a volunteer is contingent upon satisfactory references and/or results of a criminal background investigation conducted by a consumer-reporting agency.

 

I understand I am applying to be a volunteer, not a paid employee at Medical City Dallas. I understand that I am authorized solely to perform tasks assigned specifically to me. I agree to accept full responsibility and to hold harmless Medical City Dallas, its employees, directors, officers, trustees, or agents from any and all claims and damages that may arise from my participation in the volunteer program.

 

I have read and understand the above and agree to comply with all rules and regulations of Medical City Dallas and the Volunteer Services Department. I understand that failure to comply with such rules and regulations may be cause for my removal from Medical City Dallas volunteer program. Medical City Dallas reserves the right to make changes in all policies and procedures from time to time and, as may be required, changes in operations. I understand Medical City Dallas may terminate my volunteer services for any or no reason.

Please type your name and today's date into the respective fields to acknowledge the above statement.

Digital Signature (Type your full legal name)
Today's Date (MM/DD/YYYY)