Adult Volunteer Application Form
Please complete this application form if you are interested in becoming a Baptist Memorial Hospital for Women volunteer. Once you complete the form, click the submit button at the bottom.
Name and address
First name:
*
Last name:
*
Title:
Choose
Dr.
Miss
Mr.
Mrs.
Ms.
*
Street 1:
*
Street 2:
City:
*
State:
Choose
MS
TN
*
Zip:
*
Home phone:
Work phone:
Cell phone:
Email address:
Marital status:
Choose
Married
Single
Widow/widower
Spouse's name:
Emergency Contact Information
Please provide contact information in case of an emergency.
First name:
Last name:
Street 1:
City:
State:
Choose
MS
TN
Zip:
Home phone:
Cell phone:
Relationship:
Choose
Brother
Co-worker
Daughter
Father
Friend
Grandparent
Mother
Neighbor
Sister
Son
Spouse
Supervisor
Demographic Information
This information is used only to help us get a better idea of the demographic make-up of our volunteers.
Gender:
Choose
Female
Male
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
School:
Employer name:
Street 1:
Street 2:
City:
State:
Choose
MS
TN
Zip:
Work phone:
Availability
Please indicate the days and times you are usually available to volunteer.
Mon
Tue
Wed
Thu
Fri
From:
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
To:
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
I would like to serve up to:
hours:
Choose
Daily
Monthly
One time
Weekly
Assignment Preference:
Admissions Waiting Room Hostess [Baptist Memorial Hospital for Women\Admissions Department]
Central Information Desk Volunteer [Baptist Memorial Hospital for Women\Central Information Desk]
Gift Shop Volunteer [Baptist Memorial Hospital for Women\Gift Shop]
Hospitality - Surgery Waiting Room [Baptist Memorial Hospital for Women\Surgery Waiting Room]
Hospitality - Women's Health Center [Baptist Memorial Hospital for Women\Women's Health Center]
Med/Surg - Secretarial Assistant [Baptist Memorial Hospital for Women\Med/Surg Unit - 3rd Floor]
Mother/Baby Unit - Secretarial Assistant [Baptist Memorial Hospital for Women\Mother/Baby Unit - 4th Floor]
NICU/Pediatric Cuddler [Baptist Memorial Hospital for Women\Cuddler]
Nursery Volunteer [Baptist Memorial Hospital for Women\Baby Nursery]
Pediatric ER Volunteer [Baptist Memorial Hospital for Women\Pediatrics]
Pediatrics [Baptist Memorial Hospital for Women\Pediatrics]
Special Projects Volunteer [Baptist Memorial Hospital for Women\Volunteer Services]
Surgery - Secreterial Assistant [Baptist Memorial Hospital for Women\Surgery Waiting Room]
Email Preferences
We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.
What kinds of email would you like to receive?
Electronic newsletters
Informational messages to volunteers with information needed to do their job, just occasional
Recruitment appeals
Checklist reminders
References
Please enter the contact information for two people that can give you a personal reference.
1
2
First name:
First name:
Last name:
Last name:
Street 1:
Street 1:
Street 2:
Street 2:
City:
City:
State:
Choose
MS
TN
State:
Choose
MS
TN
Zip:
Zip:
Home phone:
Home phone:
Work phone:
Work phone:
Cell phone:
Cell phone:
Relationship:
Choose
Brother
Co-worker
Daughter
Father
Friend
Grandparent
Mother
Neighbor
Sister
Son
Spouse
Supervisor
Relationship:
Choose
Brother
Co-worker
Daughter
Father
Friend
Grandparent
Mother
Neighbor
Sister
Son
Spouse
Supervisor
Verified:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
Verified:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
Continue