EVENT Volunteer Application

Thank you for your interest in volunteering with Harris County Public Health! Volunteers are allowed to participate in both office and community-based projects. While clerical opportunities are often available, please let us know if you have a special skill or interest because we may be able to design an opportunity especially for you! You are encouraged to visit our website at www.hcphtx.org to learn more about the five Divisions and four major Offices that make up HCPH. The HCPH Main Office is located at 2223 West Loop South (in the Galleria area), but we have several locations throughout Harris County.

Please note that your User ID in the section below is your email address.

New User Details

User ID

User ID (verify)

Password

Password (verify)

EVENT Volunteer Application

* First Name

* Last Name

* Home Address

* City

* State

* Zip Code

* Home Phone

* Mobile phone that accepts text messages

* E-mail Address

Additional languages

Are are you at least 18 years old?

* Date of Birth

Do you have personal transportation?

Are you applying to Volunteer on a Visa?

If so, which one?

Please select any groups you are volunteering on behalf of.

If your Group is not listed, please indicate your Group name here:

Please check here if you require vegetarian food options.

Please check all skills that apply to you

Have you ever been convited of an offense? (Exclude minor traffic violations)

If yes, please explain:

* Available Starting Date

* Preferred Ending Date

Volunteer Preferences

Visit our website at publichealth.harriscountytx.gov to read more about our department. Please select the position you want to volunteer with from the list below:

Availability

Check the box of the days and times you are available.

Sunday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Monday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Tuesday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Wednesday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Thursday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Friday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Saturday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Emergency Contact

In the event of an emergency, whom should we contact?

* Contact name

* Relationship

* Home/Cell Phone

Alternative Phone

For Medical Professionals ONLY

Type of License

Active License Number

Expiration Date

State

Person verifying license

Board Certification

Please Download and Review the Following Agreement Forms:

Individuals wishing to volunteer or intern at HCPH are required to provide an electronic signature demonstrating their willingness to adhere to the required statements, releases, and agreements of the Volunteer and Internship Program.
Please read each document by clicking the link next to the file name, and then type in your name in the electronic signature box.
By providing your electronic signature you are consenting to all of our agreement forms.

Confidentiality Statement

Please click here to download

Volunteer/Intern Code of Conduct

Please click here to download

Photography Consent Form/Model Release

Please click here to download

Release and Indemnification Agreement

Please click here to download

Volunteer/Intern Participation Agreement

Please click here to download

Vaccination Requirements

Please click here to download

Volunteer/Intern Social Media Policy

Please click here to download

Non Employee County Vehicle Policy

Please click here to download

Personal Vehicle Policy

Please click here to download

HIPPA Statement Form

Please click here to download

For Medical Reserve Corps (MRC) Volunteers ONLY

Please click here to download

Volunteer Acknowledgement Waiver And Release

Please click here to download

Volunteer Standards of Conduct

Please click here to download

BACKGROUND STATEMENT I represent and warrant that I have never been charged with or convicted of a violation of any criminal statute, whether felony or misdemeanor (excluding traffic violations), and further represent and warrant that I am not now or have never been on any form of parole, probation or deferred adjudication. I hereby authorize Harris County to research my personal background, as it deems necessary, for my driving record and criminal history. I further authorize Harris County to perform a drug test if my volunteer services include safety impact duties.

* Please type your full name to electronically sign your application

* Please provide the last 4 digits of your social security number to complete your application.

Harris County Public Health EVENT Volunteer Application