Volunteer Application

Thank you for your interest in volunteering at Randolph Health! Please complete this application form as completely as possible if you are interested in becoming a Randolph Health Volunteer. Once complete, click continue at the bottom of the page.

Currently, Randolph Health requires ALL staff and volunteers to be properly masked at all times while in the facilities. The vaccination mandate is currently blocked in North Carolina but, once the block is lifted, all volunteers will be required to be fully vaccinated and boosted, or be approved for exemption.

Volunteers are also required to show proof of the annual flu vaccination or receive a vaccination from Employee Health, and pass a TB test. In addition, applicants must pass a criminal background check.

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Primary phone:

Secondary phone:

Email address:

Date of birth:

Additional Information

COVID Vaccination Status:

List language(s) spoken and proficiency:

Criminal Offenses

Social Security #:

Please list criminal convictions other than minor traffic offenses (including military):

References

Please provide contact information for two non-relative references.

1

2

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

Email address:

Please list other volunteer service in the area:

RH Volunteer Referral

If an active volunteer referred you, please list their name:

Skills & Availability

Please tell us a little about yourself. What are your skills and interests? What are your gifts and talents? Tell us why you want to volunteer. What days and times are you available?

Current Openings and Opportunities

Below is a list of open volunteer assignments and requests that need your help. Click each one to read a brief description. Choose which three are the most interesting to you.

Please Review

Believing that Randolph Health has a real need of my services as a volunteer, I will:

Be punctual and conscientious.
Conduct myself with dignity, courtesy and consideration.
Keep 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.
Endeavor to make my work of the highest quality.
Uphold the Mission, Values and Standards of this organization.

I certify the information on this application is true and any misrepresentations will disqualify me for volunteer service. Application approval is contingent on verification of the information submitted, satisfactory references and criminal background check. Randolph Health is authorized to make such investigations and inquiries deemed necessary in determining to accept me as a volunteer.

By submitting this form, I attest that the information I have provided on the form is correct.

(If submitting electronically, click "I Agree" and submit. If submitting on paper, please check "I Agree" and sign below.)

I Agree