Please complete this application form if you are interested in becoming a University of Tennessee Medical Center Auxiliary volunteer. Once you complete the form, click the submit button at the bottom.


Personal Information


Employer/School

Please list your current or most recent employer/school, if applicable.



Background Information


Reference

List the names of two people, other than relatives, who have known you for at least one year and would be willing to serve as personal references. Please include an email address for each person.



Skills and Experience

Please list any skills or experience you have that may be related to volunteering.



Physician Information

Due to the nature of hospital volunteer service, it is essential for all of our volunteers to be in good health and confine their services to jobs for which they are suited.



Emergency Contact

In the event of an emergency whom should we notify?



Information Sheet

Please select your preference of assignment from the list beginning the time. Evening and weekend hours are only in limited departments.



Volunteer Process and Work Agreement

I agree to submit to examinations, which may include chest x-rays, skin tests, physical examinations and/or immunizations that may be necessary to provide a clear health screening. The Volunteer Services Department will perform background checks on individuals 18 years of age and older, pursuant to acceptance as a volunteer of UTMC. I also agree to complete annual training to obtain information pertaining to the safety and other related topic as well as an annual performance evaluation. I agree to Volunteer Services conducting a background check. I agree to adhere to the uniform dress code as specified by the Volunteer Services Department.



Volunteer Time Commitment


I AGREE TO VOLUNTEER FOR A PERIOD OF AT LEAST 60 HOURS PER YEAR AS AN AUXILIARY MEMBER OR 40 HOURS PER SEMESTER AS AN INDEPENDENT VOLUNTEER.



Confidentiality Statement

My electronic signature on this application indicates that I agree to adhere to a strict code of confidentiality, both verbally and in written material. All information obtained from clients/patients, their records or computerized data is to be held in confidence. No copies of client/patient records shall be made and no records or computer printouts or copies thereof are to be removed from the Medical Center or its facilities unless pre-approved authorization is obtained by designated personnel. If pre-authorization is obtained, all patient information must be pre-identified. Clients/patients will not be identified in any manner in paper, reports or case studies undertaken by me unless specifically authorized. In addition, my electronic signature indicates that I will or have already read through the "Volunteer Agreement", and will take responsibility for and will be held accountable for, all the information contained in it.



Background Check Agreement

I agree to make every effort to fulfill my volunteer assignment on a regularly scheduled basis. As a volunteer, I understand the benefits offered to me are different from full/part-time paid employees. I, voluntarily and with a full understanding of the benefits which I am waiving, freely agree to abide by all existing and future policies and procedures enacted from time to time by UTMC and all requirements as they relate to my service with UTMC in order to maintain my status as a volunteer. Additionally, my services are donated to the institution without contemplation of compensation of future employment. Should I be hired in a position at UTMC as a result of my volunteer endeavors, I agree to hold blameless the institution for any claims I might have to past wages. I agree that I will be held responsible for all the information contained in this application. I understand that as a volunteer I am not covered under UTMC's worker's compensation program.



I Agree and Understand

I understand I must be a minimum of 14 years of age to volunteer at the University of Tennessee Medical Center and if I am under the age of 18 or attending high school, I must have parental consent.


I ceritfy that by agreeing to the conditions of the application, it shall serve as my signature and all information is true and has been given voluntarily. I release the agency from any liability whatsoever for supplying such information. I understand this information may be disclosed to any party with legal and proper interest.


My signature below indicates that I agree to adhere to a strict code of confidentiality, both verbally and in written material. All information obtained from clients/patients, their records, or computerized data is to be held in confidence. No copies of client/patient records shall be made, and no records or computer printouts, or copies thereof are to be removed from the Medical Center or its facilities unless pre-approved authorization is obtained by designated personnel. If pre-authorization is obtained, all patient information must be de-identified. Clients/patients will not be identified in any manner in paper, reports, or case studies undertaken by me unless specifically. In addition, my signature below indicates that I will, or have already read through the “Volunteer Agreement,” and will take responsibility for, and will be held accountable for, all the information contained in it.