Please complete this application form if you are interested in becoming a Randolph Health Volunteer.
ALL FIELDS MUST BE FILLED IN. Incomplete applications will not be considered. Once you have FULLY completed the form, click the button at the bottom.

Contact Information


Please specify the day(s) of the week you are available to volunteer and if you prefer morning or afternoon.

Skills & Experience

Please tell us a little about yourself. What are your interests and in what areas do you feel you have moderate to excellent skills? Tell us why you want to volunteer.

Earliest Date Available to Volunteer?

Please indicate the date you can begin volunteering


Do you speak a language in addition to English? Fluently?


Do you have any limitations that would affect your ability to perform the essential job functions of the position?
If yes please explain.

Criminal Offenses?

Have you ever been convicted of a crime other than a minor traffic offense (including Military Service)?

Are you charged with an unresolved criminal charge? Are you charged with a crime that has not yet resulted in a plea of guilty, court trial, deferred adjudication or dropping of the charge?


Please provide contact information for two personal (non-relative) references.

RH Volunteer Referral

Did an active Randolph Health Volunteer refer you? If so,
please list their name below.


Please list your current or most recent employer, if applicable.

Please Review

Believing that the organization has a real need of my services as a volunteer, I will:
* Be punctual and conscientious in the fulfillment of my duties and accept supervision graciously.
* Conduct myself with dignity, courtesy and consideration.
* 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.
*Take my problems, criticisms or suggestions to the Director of Volunteer Services.
*Endeavor to make my work of the highest quality.
*Uphold the Mission, Values and Standards of this organization.
*I hearby certify that the answers on this application are true and correct and that any misrepresentations or omissions of facts on my part will be grounds for dismissal as a volunteer.
*Acceptance as a volunteer is contingent upon satisfactory references and verification of the information submitted on this application/criminal background check. I therefore authorize Randolph Health to make such investigations and inquiries deemed necessary in determining to accept me as a volunteer.

I Agree

I understand and agree that submitting this application form does not automatically register me as a Randolph Hospital volunteer and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
By submitting this form, I attest that the information I have provided on the form is true and accurate.