Please complete this application form if you are interested in becoming a Mountain Health Network Volunteer. Once you complete the form, click the continue button at the bottom of the page.
Volgistics Volunteer Alerts sends reminders, alerts, and custom messages from System Operators and
Coordinators. Use this section to opt-in and opt-out of text messaging (also known as "SMS"),
and initially set how you would like to receive messages. Your messages can be delivered as emails,
text messages, or none. You can change this at any time through VicNet. View supported phone carriers.
Message and Data Rates May Apply. For help or information on this program send "HELP" to 28344.
You can send "STOP" to 28344 at any time to opt out. For additional assistance, call 888-891-6978 or
Message frequency based on account settings.
Messages are not guaranteed to be delivered. All messages will be sent by email until you respond "YES"
to the welcome text message sent after the application form is submitted. Message preferences
can be changed in VicNet on the Account tab.
I understand and agree that submitting this application form does not automatically register me as a Volunteer with any Mountain Health Network facility, 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.
I hereby certify that I have carefully reviewed and approved the foregoing information supplied by me and that this information is true and correct to the best of my knowledge. In accordance with the Privacy Act, the Freedom of Information Act and the Fair Credit Reporting Act, I expressly authorize Personnel Screening Services and any person associated with any Education Institution, past or present Employer, any Law Enforcement Agency or Court, the Department of Motor Vehicles, all necessary Government and Private Agencies, Workers' Compensation, all Credit reporting Agencies to release this information to Personnel Screening Services for the purpose of being considered for employment. I hereby release Personnel Screening Services and ALL PERSONS from liability as a result of furnishing the foregoing information. I also authorize that a copy of this RELEASE be as valid as an original.