Please complete this application form if you are interested in becoming a Maury Regional Medical Center volunteer. Once you complete the form, click the submit button below.


Contact Information


Demographics and Personal


Emergency Contact

In the event of an emergency whom should we notify?


Availability

Please indicate the days and times you are usually available to volunteer.


Assignment Preference

What kind of volunteer opportunity are you most interested in at present? To help you in your selection, click on the service area for more information.


Interests

What are you interested in doing, or willing to do (with training) as a volunteer. Check all that apply.


Skills and Experience

Please tell us more about the skills and experience you have.


Employment History

If you have been employed in the last 7 years, please complete the information below.


References

Please provide two non-family references who may tell us about your skills, abilities and capability of volunteering. Please be sure to have complete and accurate information. Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sex.


Criminal History

Have you ever been convicted of a crime except a minor traffic violation?


Additional Information

Listing any serious illness or injury in the last five (5) years that will affect your ability to volunteer?


New Volunteer Bio

Personal Information (if you want to share - marital status, children, grandchildren, pets, hobbies, etc.):


I Agree

I hereby certify the information on this application and any resulting interview is true and correct. Any misrepresentations or omissions of facts, misleading or false information on my part will be grounds for dismissal as a volunteer. Acceptance as a volunteer is contingent upon satisfactory references, background check meeting MRMC criteria, “negative” drug screen results and all other mandatory requirements. I understand that it is my responsibility to read the rules and regulations of Maury Regional Medical Center Auxiliary/Volunteer Handbook and the service description of my volunteer assignments. I agree to abide by these regulations and to perform my assigned volunteer duties to the best of my ability.