Imaging & Diagnostic Services
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Date of Birth: Sex:
Do you belong to any other Volunteer
How did you hear of our Volunteer Program?
Have you done Volunteer work before?
If yes, briefly describe:
Please indicate the type of
service you would most prefer to do:
you volunteering to meet requirements (Community Service Hours, etc) for a
you ever been convicted, on probation, or deferred adjudication for any felony
or misdemeanor? (Convictions will not necessarily disqualify an
applicant – All facts and circumstances will be considered)
yes, please explain and give dates:
I hereby certify that all
the information contained on this application is true and complete. I authorize the Memorial Hermann Healthcare
System to contact all sources necessary to verify this information and to check
references as it may see fit. I
understand that any misstatement or omission on this application is cause for
loss of volunteer privileges.
In submitting this
application to be a volunteer for Memorial Hermann Hospice; I am aware that
serving as a volunteer is a privilege, carrying high trust and related
obligations. I agree to fulfill my service commitment and to conform to all
rules and regulations of the volunteer service program.