Please complete this application (by answering all of the questions below) if you are interested in becoming a Catawba Valley Medical Center volunteer. 

Upon completion of this form, click the "SUBMIT" button at the bottom.  Once we receive your application you will receive an email regarding the next steps of the application process.

If you have any questions about whether volunteering at our hospital is a good fit for you, please contact us at jvandermolen@catawbavalleymc.org



NAME AND CONTACT INFORMATION


EMERGENCY CONTACT INFORMATION


EDUCATION AND VOLUNTEER HOURS

What is the highest level of education you have completed?

Please answer these questions in the box below"

  • Are you currently in school - YES or NO?  IF YES, where?
  • Are you applying because you are required to have volunteer hours for school?  IF YES, please explain how many hours are required for you and by when.


CURRRENT EMPLOYMENT

Are you currently employed - YES or No?

IF YES, where and what is your position?



HAVE YOU EVER BEEN CONVICTED OF A CRIME

Have you ever been convicted of a Felony OR Misdemeanor - YES or NO?

If YES, or you have any criminal charges pending against you, please explain here.



YOUR INTEREST and TYPE OF VOLUNTEER DESIRED

Please share why you are interested in volunteering with us and indicate what type of volunteer placement you would be interested in.



VOLUNTEER EXPERIENCE

Do you have any other volunteer experience - YES or NO?  

IF YES, please explain.



HOBBIES, SKILLS, LANGUAGES

List any hobbies or special skills you have and languages you speak.



HOW DID YOU HEAR ABOUT OUR PROGRAM


AVAILABILITY

Please indicate the day(s) and time(s) you are available to volunteer.



I AGREE

If accepted as a volunteer, (APPLICATION DOES NOT GUARANTEE PLACEMENT), I will keep all patient information confidential and understand that not doing so will result in dismissal as a volunteer.

If I am injured while on duty, I will report to and inform the Volunteer Services Coordinator.

I understand that all positions are voluntary and have no monetary compensation and in no way will guarantee future employment.

Please read the "I Agree" paragraphs above and check the box below.

When you click "Submit" your application will be submitted to the Volunteer Services Department of Catawba Valley Medical Center.  Please make sure everything is complete before submitting your application.  Thank you for your interest in volunteering.