Thank you for your interest in volunteering at Randolph Health! Please complete the following application. Required information is marked with an asterisk (*).

Currently, Randolph Health requires staff and volunteers to be masked at all times in our facilities AND be fully vaccinated against Covid-19 or exempted through Randolph Health's committee. Other requirements include a health history, seasonal flu shot (if applicable), a negative TB screening test and a background check.

Contact Information

First name:

Last name:

Street:

Street 2:

City:

State:

* Zip: *

Primary phone:

Secondary phone:

Email address:

Date of birth:

Additional Information

COVID Vaccination Status:

Other Language(s) Spoken?

Criminal Offenses

Social Security #:

Criminal convictions other than minor traffic offenses?

Reference

Please provide contact information for a non-relative reference.

First name:

Last name:

Primary phone:

Secondary 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.

Assignment Preference:

Comfort Care Donations [Volunteer Services]

Greeter | Navigator [Outpatient Center]

Greeter | Navigator [Visitor Center]

SDS Eye Day [Departments]

Snack Donations [Volunteer Services]

Surgery Support Representative [Departments]

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