Dear Prospective Volunteer,

Joining our dedicated team of volunteers can be a richly rewarding experience for you. Our volunteers serve our community and our medical center through compassion, dedication and financial support, donating countless hours and touching numerous lives. It is true that in sharing the burdens of others, one gains strength to bear our own.

Thank you for your interest in becoming a Baxter Regional Medical Center Auxiliary volunteer. Once you complete the form, click the submit button at the bottom. We are waiting to hear from you!


BRMC Purpose Statement: To preserve BRMC as a comprehensive, independent, community-driven health system in order to optimize access to quality healthcare for patients in the community we serve.

Name and address


References

Please provide us contact information on 2 personal references. PLEASE EXCLUDE ALL RELATIVES as a PERSONAL REFERENCE.


Emergency Contact

Please give us contact information on someone you want us to contact should something happen to you while volunteering.


Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.


Availability

Please indicate the days and times you are usually available to volunteer.


Assignment Preference

Please check all boxes that apply to your interest in volunteer opportunities at Baxter Regional. Click on the highlighted assignment for more information.


Former Employee or Volunteer for Baxter Regional

If you have ever been a former employee or volunteer for Baxter Regional, please list dates and what department you worked in or volunteered.


Experience Information

Please list Employer, if currently employed and their contact information. Also list any other business experience or volunteer experience.


Membership

We ask our volunteers to donate 40 hours a year to be considered Active. Annual Dues for Active Volunteers are $5.00. We are members of the Arkansas Hospital Auxiliary Association which keep us informed of rules, regulations and legislation that we need to be aware of as volunteers in health care. (Attendance at Auxiliary General Meetings in September, November, December, February, March and April is welcomed.)


Felony

If you have ever committed a felony, please give dates and details.


Criminal/Reference Checks & Non-Discrimination

Your submission of this application indicates your approval for us to do a criminal background check and check references. Also, you are agreeing that you are at least 16 years of age and will obtain parental or guardian consent to volunteer with our organization if you are under 18 years of age. The organization is not obligated to provide a placement, nor are you obligated to accept the position offered.

Opportunities for volunteers are provided without regard to race, color, religion (creed), gender, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, or any other unlawful or prohibited discrimination in any of its activities or operations. We are committed to providing an inclusive and welcoming environment for all.