If you are interested in volunteering please complete the form below: I am applying as a: * RequiredCollege Volunteer (Over the age of 18)Adult Volunteer (Over 18)IName: * Required First Middle Last Address: * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone Number:Cell Number:Email Address: * Required Sex: * RequiredMaleFemaleBirthday: * Required MM DD YYYY Preferred method of communication: * RequiredPost MailEmailIf you are currently employed, please list your employer:Spouse’s/Partner’s Name:Please list your Spouse’s/Partner’s employer:Emergency Contact: * RequiredAddress: * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Telephone: * RequiredWork Telephone:IIWhat days and times are you available to volunteer:Days: * Required Monday Tuesday Wednesday Thursday Friday Saturday Sunday Times: * Required Mornings Afternoons Evenings Please note: The Director of Volunteer Services, after consulting with the Volunteer President, has the right to dismiss a volunteer at any time for any reason, including inappropriate behavior, failure to follow Seton policies and procedures, and or unreasonable conflicts with patients, staff, or visitors.IIIPlease list your past and current work and volunteer experiences:Organization Name:Your Position:Organization Name:Your Position:What did you like most about your work/volunteer experience?What did you like least?Number of years in the workforce: * RequiredIf retired, who was your last employer?Other organizations to which you belong:IVWhy are you interested in volunteering at the Seton Family of Hospitals and what would you like to gain from your experience here? * RequiredVHow did you hear about our Volunteer Program? * RequiredVIPlease list the names of any friends or relatives who volunteer at Seton:VIIPlease list 3 references other than relatives:Name: * RequiredPhone * RequiredEmail: Name: * RequiredPhone: * RequiredEmail: Name:Phone:Email: VIIIVolunteer Statement I hereby give permission for Seton Family of Hospitals to obtain information relating to my criminal history record through the Texas Department of Public Safety. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudication. I understand that this information will be used, in part, to determine my eligibility for a volunteer position with this organization. I also understand that as long as I remain a volunteer here, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received. I, the undersigned, do, for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify Seton Family of Hospitals, and each of their officers, directors, employees, and agents harmless from and against any and all causes of action, suits, liabilities, costs, debts, and sums of money, claims and demands whatsoever, and any and all related attorneys’ fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become a volunteer/staff member. * Required I have read the above agreement, I understand its contents, and I agree to its terms Criminal Background Checks Policy Policy Out of concern for the well-being and safety of the patients and families we serve, Seton Family of Hospitals performs criminal background checks on adult and college volunteers. Seton Family of Hospitals deems it necessary and advisable as a matter of policy to reserve the right to disqualify and prohibit any person from serving as a volunteer, including one who has been arrested for, convicted of, been on probation for, or received deferred adjudication for any criminal conduct. The right to disqualify applies to any criminal conduct, regardless of whether (a) the criminal charges were subsequently dropped and the applicant was never prosecuted for the crime charged, or (b) the criminal charges resulted in a non-conviction such as probation, or (c) the criminal conviction was subsequently expunged from the applicant’s record as the result of appropriate legal proceedings. Procedures In order to screen prospective volunteers to identify those who have engaged in criminal conduct, Seton Family of Hospitals adopts the following procedure: Application: Each volunteer is required to complete an application. Personal Interview: Each prospective volunteer will undergo an interview with an appropriate staff or a Board Member of the Seton Family of Hospitals Volunteer Offices. Criminal Background Checks: Each prospective volunteer will give written consent for a criminal background check, conducted by the Volunteer Department, a service of the Seton Family of Hospitals. The form of authorization will be that prescribed by the Volunteer Department. Compliance with Requirements Seton Family of Hospitals will comply with the requirements of the Criminal Information Act, including the destruction of criminal history record information promptly after the determination of the suitability of the volunteer.Enter Your Current Legal Name: * Required First Middle Last Enter any previously used names below: First Middle Last Have you ever been convicted of a crime and are there any legal charges pending against you?YesNoIf yes, please explain: (Please note: Seton HealthCare Family does not participate in court ordered community programs.)CommentsThis field is for validation purposes and should be left unchanged.