Please complete this application form if you are 19 years of age or older and interested in becoming a Southeast Georgia Health System volunteer. Please note, this is not an application for shadowing or observation opportunities. Once you complete the form, click the submit button at the bottom.

Contact Information


Demographics

This information is used to help us get a better idea of the demographic make-up of our volunteers and to verify that applicants are nineteen years and older.


Emergency Contact

In the event of an emergency, whom should we notify?


Education

If you are currently enrolled in school please provide the name of the school and your major/area of study. Be sure to tell us if volunteer hours are required.


Employment

What is your current employment status? Are you currently employed, seeking employment or retired? Please explain. If you have ever been employed by a Southeast Georgia Health System facility please provide dates of employment and department.


Motivation for Volunteering

Why do you want to volunteer at Southeast Georgia Health System?


Volunteer Experience

Tell us about your volunteer experience. Please provide the name of the organization(s) and a description of your volunteer tasks, including any previous volunteer experience with Southeast Georgia Health System if applicable.


Skills & Interests

Please provide a brief description of any special skills, talents or interests that may help us determine your volunteer placement.


Select Site Preference

Please indicate which location you would like to volunteer.


Availability

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


Criminal Background Information

Have you ever been convicted of a crime other than minor traffic violations? Answer yes or no. If yes, please list the offense, date of conviction and where you were convicted (city/state).


How Did You Hear About Us?

How did you hear about Southeast Georgia Health System Volunteer Services? (SGHS Website, SGHS Publication, Newspaper, Friend, School, Internet, Employee Name, Volunteer Name, SGHS Human Resources)


Agreement To and Certification of Information

I certify that the information given by me in this application is true in all respects and I agree that, if the information given is found to be false in any way, it shall be considered sufficient cause for denial of volunteer service or discharge. I authorize the use of any information in this application to verify my statements and I authorize all references and any other persons to answer all questions asked concerning my education, ability, character and previous volunteer records. I understand that this information will be used solely for the purpose of determining my qualifications for volunteer service and hereby release from liability any organizations I do/did volunteer for as well as my references and Southeast Georgia Health System for use of this information in making volunteer onboarding decisions.

I understand and agree that submitting this application form and completing a volunteer interview does not automatically register me as a Southeast Georgia Health System volunteer or guarantee volunteer placement. I further understand that should a volunteer position be extended to me it is at will and may be terminated with or without cause or notice at any time at the option of the organization or myself. I understand that by serving as a volunteer I will donate my services to the organization without contemplation of compensation or future employment.
I further understand that if a volunteer position is offered to me, it is conditioned upon my successful completion of:
• a background check which may include criminal, OIG/DHHS sanctions and/or driving checks as well as a personal reference check
• a tuberculosis skin test screening and flu vaccine requirement
• a new volunteer orientation class

In the event I have a disability which will affect my ability to perform the essential functions of a volunteer position, I will so inform Southeast Georgia Health System so a reasonable accommodation may be requested. I also understand that accommodation beyond a reasonable level may not be made by Southeast Georgia Health System and that may preclude my eligibility for volunteering. Southeast Georgia Health System reserves the right to require medical documentation concerning the need for the accommodation.

I understand Southeast Georgia Health System is a tobacco-free campus and the use of tobacco products is prohibited.

I understand this application will be kept on active file for 90 days from the date completed, after which time I would have to reapply if I had been offered a volunteer position but did not complete the volunteer onboarding requirements.

I acknowledge by checking the “I agree” box below that I have read and understand these statements.