Volunteer/Intern Application

Thank you for your interest in volunteering with the Texas Health and Human Services Commission (HHSC)

Services

Select Type of Service*

General Information

Please provide your contact information (*= Required Field):

Last Name*

First Name*

Middle Initial

Home Area Code and Telephone #*

Work Area Code and Telephone #

Cellular Area Code and Telephone #

List all names you have ever used

I affirm that every name I have ever used is listed above.

Address

City

County

State

Zip

Date of Birth*[ 4/6/2025 ]

Sex

Email Address*

Current Employer

Employer Address

Employer Phone #

Have you been convicted of any type of criminal offense?

Judicial Court Assignment

Emergency Contact

Name

Relationship

Day Telephone #

Evening Telephone #

Placement

Select Placement Type*

Interest/Background

Have you volunteered with a State Agency before?

Are you bilingual?

Please share skills and interests you would like to use

Date available to start[ 4/6/2025 ]

Select the Days and Times you would like to volunteer(Hold the Ctrl key to select more than one)

Assignment Preference(Hold the Ctrl key to select more than one)

Notes/Accommodations

Confidentiality Statement - I agree to respect the confidential nature of all personal contact with individuals served by HHS and adhere to all laws, rules, policies and procedures pertaining to confidentiality regarding all records, files and identifying information of individuals, former or potential with whom I come into contact as a volunteer. I understand violation of this confidentiality requirement can result in immediate dismissal from my volunteer assignment.

Affirmation - By my signature, I adhere to all departmental rules, policies and procedures pertaining to my volunteer placement. Access to a copy of the Volunteer Procedure Manual will be provided to me during orientation. I understand that I must complete all required orientation and placement-specific training outline by the Volunteer Assignment Description. I affirm that the information on this application is accurate to the best of my knowledge.

Date[ 4/6/2025 ]

Signature*

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