Odessa Regional Medical Center Auxiliary Application

The Auxiliary of ORMC is a non-profit organization chapter of the Texas Association of Health Care Volunteers that functions through the service of its members. It is governed by an executive board consisting of elected members. Volunteers accrue hours by providing service to the hospital, attending meetings, special events and annual orientation, and includes time spent for board service. The application process involves a background screening, annual orientation, training, annual dues, drug test by urine analysis, tuberculosis screening and a commitment of at least 6 hours a month or total of 72 hours of service each year.

Prior to submitting your application, please click here and fill out our background check form and attach to your submission.

Date*

General Information

First Name*

Last Name*

Address*

City*

State*

ZIP/Postal Code*

Phone Number*

Email*

Marital Status*

Name of Spouse

Emergency Contact

First Name*

Last Name*

Emergency Contact Phone Number*

Emergency Contact Address

City/Town

State/Province

ZIP/Postal Code

Volunteer Program Questions

Are you able to commit to at least 6 hours of volunteer service a month?

Yes

Days available (pick all that apply)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What shift(s) are you available to work?

8 am - noon

noon - 4 pm

How many hours a month can you serve as a volunteer?

What traits do you have that would make you a valuable volunteer?

Please describe your health and any physical limitations?

Personal Reference

I hereby authorize Odessa Regional Medical Center to conduct a background check, drug screen and TB skin test as a condition of my acceptance into the ORMC Auxiliary.

I agree to participate in New Volunteer Orientation, any job-specific instruction, and the Annual Orientation as required by the hospital and pay organization dues for the Texas Association of Healthcare Volunteers.

I shall hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, doctors or personnel, and not seek to obtain confidential information from a patient.

My services are donated to the hospital without contemplation of compensation or future employment and given with humanitarian or charitable reasons.

I shall not sell or attempt to sell goods or services, request contributions, or solicit persons to sign or distribute political petitions on hospital premises unless I receive the express authorization of the Director of Volunteer Services to engage in these activities.

I shall at all times uphold the philosophy and standards of the hospital.

I shall be punctual and conscientious, conduct myself with dignity, courtesy and consideration of others, and endeavor to make my work professional in quality.

I understand that the Identification Badge issued to me is the property of the hospital, and I agree to return it upon leave of absence, termination of volunteer service or whenever requested by staff to do so.

I have read each of the above conditions and I agree to be bound by them.

Signature

Sign above

For more information contact the ORMC Marketing Coordinator at the ORMC Marketing Department at 432-582-8796

File*

Background Check Form
One file only.
30 MB limit.
Allowed types: jpg, png, pdf, doc, docx, zip.