We appreciate your interest in UNC Rex Healthcare and are sincerely interested in your qualifications to serve our patients and their families. Questions on this application are asked for the sole purpose of considering you for volunteer service. Please answer the questions completely and proofread the application.


Once you complete the form, please read the terms and check the "I agree" box and click the Continue button at the bottom of the page.


Please note that there is a separate application for the VolunTEEN Program. The College Program utilizes the Adult Application. However, the application link is provided on UNC Rex's Volunteer Services College page only when the College Program is accepting applications.

UNC Rex Healthcare does not discriminate in hiring or employment on the basis of race, color, sex, religion, national origin, disability, or age.


Name and address

Please make sure you include at least one phone number where you can be reached. Please be sure information is correct. This will be used to send you information in the future. Please check the day and general time you are available to volunteer at UNC Rex.


Work Experience and Skills

Please enter your present occupation under "Work experience" along with your current employer. If you are not currently work, please describe the skills and qualities you would bring to a volunteer assignment.


Prior Experience at Rex Healthcare


Education


Community Organizations


Relatives

Please tell us anyone you are related to who is employed by or volunteers at UNC Rex Healthcare. Please include the department in which the person works and his/her relationship to you.


Violations


Special Program(s) and Relationships

If you are working with a special program for credit (club, court, etc.), please list the name of the organization, a reference person and a telephone number where they can be reached.


Volunteer Interest


References

*Please enter TWO adult references (must be over 21 years of age) WHO ARE NOT RELATIVES and who have a knowledge of your work habits and skills.
*Be sure to include a valid mailing address including first and last names and complete mailing information.

*Applications without complete mailing information will not be considered. If you are sending the reference letter to a home address, you do not have to include Employers Name.

*References will not be contacted by phone. The relationship drop down box is used for both are you related to anywho who works at Rex and references.

*Note that because a relationship is listed in the drop down box does not mean it can be used as a reference.


E-mail options

Please enter what types of e-mail you would like to receive.


Authorization & Agreement

Please check the 'I agree" checkbox to indicate that you agree to the following terms.

1) I authorize UNC Rex Healthcare to conduct a criminal background investigation. I understand that if the infomation provided by me is determined to be false or if I have failed to give any information herein requested, I will no longer be considered for volunteering. In the event of my acceptance as a volunteer, if the above occurs, this may be cause for dismissal.

AND

2) I hereby certify the answers on this application and any resulting from interviews are true and correct and any misrepresentation or omissions of fact, misleading or false information on my part will be grounds for dismissal as a volunteer. Acceptance as a volunteer is contingent upon satisfactory references, verification of the infomation submitted on this application and satisfactory completion of mandatory requirements, including drug screening. I authorize that all employers, schools, or references thus contacted be released from all liability in answering questions related to my application. I therefore authorize you to make such investigations and inquiries you deem necessary in arriving at a decision to accept me as a volunteer.