Please complete this application (by answering ALL of the questions below) if you are an adult or college student interested in becoming a volunteer at Novant Health Kernersville Medical Center located in Kernersville, NC.


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 marmstrong@novanthealth.org.


NAME AND 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 of you and by when. (IMPORTANT: this application is not to be used for internships, observations or shadowing. For internships, observations or shadowing please disregard this application and visit www.novanthealth.org/studentprograms or email studentprograms@novanthealth.org.)



CURRENT EMPLOYMENT

Are you currently employed - YES or NO? IF YES, where and what is your position?



NOVANT HEALTH EMPLOYMENT

Have you ever been employed by Novant Health - YES or NO? IF YES, when and where?



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.



NOVANT HEALTH MISSION, VISION, SERVICE STANDARDS

Novant Health exists to improve the health of communities, one person at a time, by delivering the most remarkable patient experience in every dimension, every time. Our Service Standards are:


* KNOW ME: I will be fully present and attentive when I am with you

* RESPECT ME: I will honor you as an individual

* CARE ABOUT ME: I will be there for you in the way that you need

* DELIGHT ME: I will think ahead and go the extra mile for you


As a volunteer, how do you believe you can help achieve this Mission and which of the four Service Standards do you believe is most important and why?



YOUR INTEREST and TYPE OF VOLUNTEER WORK 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


FRIEND OR RELATIVE EMPLOYED BY NOVANT HEALTH


AVAILABILITY

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



I AGREE

As a potential volunteer, I agree and acknowledge that the information I provide on this application or in any upcoming interviews is true. Any misrepresentation or omission of facts, or misleading or false information on my part will be grounds for non-acceptance into this program. I understand that volunteers represent and are a part of the Novant Health system, and are subject to all rules, regulations and to proper authority. I also give permission for you to contact my references.


The Volunteer Services Department is not obligated to provide a placement, nor are you obligated to accept the position offered. Volunteer Services does not accept as a volunteer anyone needing court-appointed community service hours.


All applications are held for 90 days. If accepted into the program the first 90 days of the volunteer experience will be probationary.


Volunteer Services considers all applicants for placement without regard to race, color, religion, sex, national origin, age, disability, veteran’s status, marital status, sexual orientation, gender identity or expression.


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 at Novant Health Kernersville Medical Center. Please make sure everything is complete before submitting your application. Thank you for your interest in volunteering.