March 2015 Attention: High School Students (including homeschool, private high school, parochial students) – Sophomores, Juniors and Seniors Dear Junior Volunteer Applicant: Thank you for your interest in our Junior Volunteer Program at Conroe Regional Medical Center. Our program starts June 15, 2015 and extends through August 14, 2015, for a total of nine weeks. In order to receive a certificate of service all junior volunteers must serve a minimum of forty (40) hours. A full day of orientation will be held on Wednesday, June 10, 2015, and is mandatory for all participants. Orientation will start at 9:00 a.m. in the CRMC Auditorium. Volunteering will begin Monday, June 15, 2015. If you wish to be considered, please submit your completed application (pages 1-6) before May 1, 2015. You may submit your completed application via mail to the Volunteer Office (address below) or fax it to (936) 539-7528. Please keep this letter and pages 7 - 11 to refer to. Please feel free to make as many copies of the application needed to give students in the 10 th, 11th, and 12th grades. If you have any questions please call the Volunteer Office at 936-539-7433 or Millie Whaley at 936-4474797. We appreciate your interest and look forward to hearing from you. Sincerely, Mille Whaley Junior Volunteer Director Conroe Regional Medical Center Attn: Volunteer Services 504 Medical Center Blvd. Conroe, Texas 77304 Phone: 936-539-7433 Fax: 936-539-7528 Application for Junior Volunteer Program Please Print Name_______________________________________ Last First Middle Gender (circle one): Male or Female Birthday _________/________/_________ Month Day Year Street address _______________________________________ Phone _________________________ City and Zip ___________________________________________ Cell __________________________ E-mail address _______________________________________ SS# ____________________________ High school _________________________________________ Grade next fall __________________ Father's name _______________________________________ Occupation _____________________ Mother's name ______________________________________ Occupation______________________ In case of emergency, contact: __________________________ Relationship _____________________ Emergency Phone __________________________ Personal Physician _________________________ Community affiliations (Clubs, Associations, Church, Etc.): Why are you interested in volunteering? ___________________________________________________ Shirt Size (circle one): S M L XL XXL Special interests, talents or hobbies: _______________________________________________________ List three adult references (other than relatives): 1. ______________________________ School Teacher or Counselor 2. ______________________________ 3. ______________________________ ___________________________________________________ Address Phone ___________________________________________________ Address Phone ___________________________________________________ Address Phone Are you willing to have your references evaluate and give their recommendations to Conroe Regional Medical Center? (Circle one): Yes or No Signature __________________________________ Date _______________________ 1 Parental Consent Form To: Auxiliary of Conroe Regional Medical Center 504 Medical Center Blvd. Conroe, TX 77304 My daughter/son _______________________________ (print first and last name) has my consent to serve as a Junior Volunteer at Conroe Regional Medical Center. She/he has permission to be vaccinated for TDAP (Tetanus, Diphtheria, Acellular Pertussis) and screened for Tuberculosis via a blood test called QFT, in the event that they are not able to submit documentation of these by a healthcare provider to the employee health office before beginning the program. Students: Age_______________________ Grade Next Fall______________ School_____________________ The following lists days he/she will be away this summer (not to exceed one week): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________________________________ Signature of Parent _______________________________ Date __________________________________ Street Address _______________________________ Home Phone __________________________________ City and Zip _______________________________ Cell Phone 2 Auxiliary of Conroe Regional Medical Center Volunteers Pledge of Service: ____________________________ (print first and last name) accept membership as junior volunteer of the Auxiliary of Conroe Regional Medical Center. I promise to conduct myself with dignity, courtesy, and consideration for others at all times. I will be punctual and conscientious in the fulfillment of my duties and accept supervision graciously. I will consider as confidential all information, which I may hear concerning a patient, staff member or employee. I will endeavor to make my work of the highest quality and uphold the rules and ethics of the Auxiliary of Conroe Regional Medical Center, and hospital regulations to the best of my ability. I pledge to properly represent the hospital both as I work and in my living, to the end that all may know of the great services performed at this institution. I understand that my failure to comply with the above standards will result in my immediate dismissal. _______________________________________ Signature ___________________________________ Date 3 Purpose of a Hospital Volunteer Program The hospital staff is looking forward to the Junior Volunteer program at our hospital. We recognize these juniors as excellent prospects for hospital careers. The purpose of a hospital is to promote public welfare through development of better patient care for all the people. The purpose of a hospital volunteer program is to assist the hospital in the development of this better patient care by providing volunteer services, promoting better understanding between the hospital and the community. As a member of the Junior Volunteers you share in the teamwork of contributing to better patient care, which is the ever present goal of our hospital. The functions of the Junior Volunteer program are to provide volunteer service, to increase the community's understanding and interest in the hospital, and to stimulate the interest of its members in health careers. Each junior volunteer serves as a link between patient and hospital and between hospital and community, and the volunteer services is an outreach of warmth, generosity, and concern that symbolizes the message: "this is MY hospital." Such a program specifically gives teenagers an opportunity to observe hospital life behind the scenes. The cheerfulness, enthusiasm and spirit of the junior volunteer are a most important public relations program. Junior Volunteer Pledge: Believing that the hospital has real need of my services as a volunteer worker: • • • • • • • I will be punctual and conscientious in the fulfillment of my duties and accept supervision graciously. I will conduct myself with dignity, courtesy and consideration. I will consider as confidential all information which I may hear directly or indirectly concerning a patient, doctor or any member of personnel and will not seek information in regard to a patient. I will take any problems, criticisms or suggestions to the Volunteer Coordinator. I will endeavor to make my work of the highest quality. I will uphold the traditions and standards of the highest quality. I will uphold the traditions and standards of this hospital and will interpret them to the community at large. Signature: ____________________________________ Date: _____________________________ 4 5 6 The Junior Volunteer program is sponsored and supported by the Auxiliary of Conroe Regional Medical Center. The Auxiliary provides special awards, financial support and assures the continuity and direction of the Volunteer Coordinator and Auxiliary Director of Junior Volunteers. Qualifications: A Junior Volunteer is a high school student, possibly a medical career student, who is interested in serving the hospital, its patients and the community. She/he maintains a scholastic average of "C" or better. Parents must submit their approval in writing. Junior Volunteers must maintain good physical and mental health and have a sincere interest in helping others. All applicants must interview with the Auxiliary Director of Junior Volunteers. If accepted, they must attend an orientation and training meeting before beginning their assigned duty in the hospital. They will receive their assignments through the Volunteer Services department or the Auxiliary Director of Junior Volunteers and will provide service for the area they are assigned. Failure to follow your assigned duties can result in termination from this program Goals: • To offer valuable service to the hospital and the community. • To learn the meaning of service to the hospital patients. • To provide exposure to hospital atmosphere in deciding upon a career in the health field. • To acquire knowledge of the health needs of individuals and ways of maintaining health. Benefits: • Complimentary lunch with scheduled assignment. • Career decisions for students interested in healthcare • Opportunities for new friendships. • Continuing educational experience. Uniform: All junior volunteers will wear a green polo shirt purchased from the Auxiliary and khaki pants with white tennis shoes. Please report for duty in clean, pressed uniform, with shoes polished or clean. The uniform should only be worn when on duty in the hospital. 7 Hair length will be above the shoulders and away from the face. If hair is long, tie it up and fasten securely. Hair should never be loose on the shoulders. • No accessories, except a white sweater if needed. • No jewelry other than watches. No earrings except small studs for pierced ears. • No heavy makeup or bright fingernail polish. • Personal hygiene should include clean nails and hair, daily bath, deodorant and mouth hygiene. • No perfume or cologne. Some patients may be allergic to odors or may be nauseated after anesthesia. • Keep hands dean from germs by washing hands thoroughly before and after caring for each patient. • Stand tall and wear a sincere smile. Remember body posture. • Stay at home when you are ill, but be sure to call in 936.539.7433 (leave a message if no one is there to answer the phone). Rules of Conduct: The privilege of being a Junior Volunteer carries with it the responsibility of being loyal to the hospital. You are working in an adult world and therefore are expected to carry adult responsibilities toward the patients, hospital personnel, other volunteers and the hospital itself. Study these rules carefully. - Adhere to instructions issued by personnel in charge and adhere to hospital routine. - Hospital affairs are strictly confidential and must be so regarded by Junior Volunteers. Avoid discussion with family or friends any information regarding any patient. - Always get permission from the nursing staff before visiting a hospitalized friend. - Perform duties in accordance with established methods of the hospital. Assist patients in a manner conducive to their safety and comfort When in doubt as to any policy or procedure, ask your supervisor. - Act at all times in a dignified and considerate manner. While at the hospital you are a part of it, and should be above criticism. Be patient and cheerful. - Remain inside the hospital while on duty. - Avoid asking patients why they are in the hospital. - Do not give your name and phone number to anyone. 8 - If you are injured on the job, have someone notify the Volunteer Coordinator and if possible wait for further instructions. - A fifteen-minute break is allotted for each shift. Let your supervisor in the area of your assignment know that you are leaving and when you return for duty. Soft drinks, gum chewing and candy bars may only be enjoyed in the cafeteria vending area or the volunteer workroom. - Being a Junior Volunteer does not include medical services or reduction in hospital rates for yourself or family members. Medical advice should not be sought from staff physicians for yourself or others. - At all times, your voice should be kept low and audible, showing courtesy and tactfulness at all times. Remember, you are a host/hostess for the hospital. - The information desk is not a gathering place. Suggestions if you need something to do: Visit patients, distribute magazines to waiting areas, and tidy up tables in waiting areas. - Your friends may not visit you while you are on duty and telephone use is limited to transportation needs and/or emergencies. - Junior Volunteers are to leave the hospital immediately after their shift ends. 9 2015 Junior Volunteer Vaccine Information Effective September 1, 2012 Conroe Regional Medical Center has adopted a policy in regard to Healthcare worker vaccine preventable diseases. This policy is in compliance with the Texas Health & Safety Code, Article 8, Chapter 224 and it specifies that individuals volunteering at CRMC will be vaccinated for TDAP (Tetanus, Diphtheria, Acellular Pertussis) prior to volunteering. In addition to this, a screening for Tuberculosis, a blood test called QFT, will also need to be completed. As a junior volunteer you will be required to submit proof of the above by submitting documentation of these by a healthcare provider to the employee health office. In the event that you cannot submit documentation of these you can be seen in the employee health office and the health nurse will provide these to you at no cost. The volunteer office will provide the employee health office with a list of junior volunteers to contact. An employee health nurse will contact you and schedule a time for you to come in to receive your vaccine and/TB Screening and or make arrangements to obtain a copy of your vaccine records. You may also fax your records to the employee health office at (936)539-7506. In the event that you need to reach an employee health nurse please contact (936) 539-7469. 10 Junior Volunteer Program Checklist and Important Dates Checklist: _____ Completely and legibly filled out and pages 1- 6 of the application including signatures _____ Mailed or faxed pages 1-6 to the volunteer office by April 30th (late applications won’t be considered) Conroe Regional Medical Center Attn: Volunteer Services 504 Medical Center Blvd. Conroe, Texas 77304 or Fax #: 936-539-7528 _____ Checked with your healthcare provider to obtain copy of TDAP (Tetanus, Diphtheria, Acellular Pertussis) Vaccine records and had a copy faxed over to 936-539-7506 or the hospital will provide you one free of charge. _____ Contacted the employee health office at (936) 539-7469 to make arrangements to receive vaccine and/TB Screening and/or to confirm they received a copy of your vaccine records. Important Dates: Date April 30, 2015 Scheduled date of: __________ June 10, 2015 June 15, 2015 August 14, 2015 TBD – will send out notice Event Completed volunteer application is due (pages 1-6) Employee Health Appointment to receive TDAP vaccine and T/B Screening. Call employee health to schedule a day/time. Half day of orientation (8:00 AM – Noon) in CRMC Auditorium Junior Volunteer program starts Junior Volunteer program ends Award Ceremony at Incredible Pizza
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