Please complete this application form if you are interested in becoming a Reliant Medical Group volunteer. Once you complete the form, click the submit button at the bottom.

Demographic Information

Emergency Contact


Additional information:

Previous volunteer experience

Please summarize your previous volunteer experience, if any.

Special skills

Please summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including languages, hobbies, interests and talents.


A letter of reference from a non family member is required to be submitted as part of the application process.

If applicant is under 18 years of age.

Applicants under the age of 18 will be required to submit a signed parental consent form which will be provided prior to the volunteer interview.

Additional Requirements

The following documents will be required prior to scheduling a volunteer interview: Immunization records for MMR and Varicella, a PPD test within 12 months, completion of the volunteer application packet to be emailed to you once application is received.


In connection with your application to volunteer, Reliant Medical Group, Inc. may obtain a CORI/Consumer Report for security purposes. By checking the "I Agree" checkbox you authorize Reliant to be used for application purposes now and at any time while you volunteer at Reliant.