Public Law 91-508 requires that we advise you that a routine inquiry may be made which will provide information concerning your character, reputation and personal characteristics, and mode of living. You may obtain a copy of this information upon written request.

I hereby certify that the information I supplied in this application is true, complete and correct to the best of my knowledge and I understand that any information I withheld or falsely provided in connection with the foregoing shall be cause for rejection of this application or termination of volunteer status. I hereby authorize The Methodist Hospital, without liability, to contact prior employers (present employers if authorized), schools, or references I have given and authorize said employers, schools, or references to make full response to any injuries by The Methodist Hospital in connection with this application for volunteer service. I understand, and agree that as a condition of my acceptance in The Methodist Hospital Volunteer Program, I will be required to pass scheduled physical examinations as they relate to my ability to discharge my duties.
IF ACCEPTED AS A METHODIST VOLUNTEER, I AGREE THAT:

1. I will use confidential information only as needed to perform my volunteer duties. I will not access confidential information without legitimate need/permission, nor in any way divulge, copy, release, sell, lend, revise, alter, or destroy any confidential information belonging to The Methodist Hospital. I understand that I will be automatically dismissed as a volunteer if I do not respect my responsibility for maintaining confidentiality.

2. My services are donated to the hospital and given for humanitarian, religious, or charitable reasons.

3. I understand that it is a crime to solicit business for attorneys. I shall not solicit any business for attorneys or insurance companies, both on or off of hospital property, or act as a runner or capper for an attorney in the solicitation business. I shall report all known occurrences of solicitation for attorneys to the Director of Volunteer Services.

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

5. I shall submit to the physical screenings, which may include chest X-rays, skin test, and appropriate laboratory test, as a condition of my acceptance into the volunteer program. I also authorize the person(s) performing tests or x-rays films to report the results to the hospital.

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

7. I shall attempt to resolve any problems related to my volunteer activities with my unit/department supervisor, and, if unsuccessful, attempt to resolve any such problems with the Director of Volunteer Services.

8. I shall make my best effort to fulfill my commitment to the hospital by completing all assignments that I accept.

9. I shall at all times uphold the mission of the hospital.

10. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status as a result of (a) failure to comply with hospital policies, rules and regulations; (b) 3 absences without prior notification; (c) unsatisfactory attitude, work or appearance; or (d) any other circumstances which, in the judgment of the department Director, would make my continued service as a volunteer contrary to the best interests of the hospital.