We appreciate your interest in UNC Rex Healthcare and are sincerely interested in your qualifications. Please complete this application form if you are interested in becoming a UNC Rex Healthcare volunteer. Please take care to check the accuracy of the information. Also provide detailed information as to why you would make an excellent volunteer at UNC Rex. Once you complete the form, click the "I agree" button at the bottom.


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


Name, address, and availability

Please make sure you include at least one phone number where you can be reached. Also indicate the dates and times that you are available to volunteer.



College Information

Please complete this section to include your currect college, major, and anticipated graduation date. Include your permanent mailing address.



Personal Employment

Please enter your present occupation under "Work Experience" along with your current employer.



Prior Experience at UNC Rex


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.



Volunteer Interest


References

Please enter TWO adult references (must be over 21) 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. References may be contacted via email.



Violations


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 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.