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.


Contact Information

Make sure to "Opt In" to Text messages and Email Notifications.
These are our exclusive methods of communication.


Demographics

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.


Interests

What would you be willing/interested in doing as a volunteer?


Availability

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


Assignment Preference

The following volunteer assignments may currently be available.

Click on the name of the assignment for a description.

Check all assignments that you would be willing to serve in.


Emergency Contact

In the event of an emergency whom should we notify?


Employer

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


Criminal History

A pre-requisite to employment or acceptance as a volunteer is the completion of a Criminal Background Check.

Have you ever plead guilty or "no contest" (nolo contendere) to, or been convicted of, violating any law with the exception of minor traffic violations?


Anything Else?


I Agree

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.