Please complete this application form if you are interested in becoming a Kernersville Medical Center volunteer. Once you complete the form, please read the "I Agree" section and then click "Continue" at the bottom. After submitting the application, you will receive a separate email regarding the next steps of the process.


If you have any questions about whether volunteering is a good fit for you, please contact Missy Armstrong at 336.564.4822 or at marmstrong@novanthealth.org.


NAME AND CONTACT INFORMATION

Please compelte this information about yourself.



EMERGENCY CONTACT INFORMATION

Please provide the following emergency contact information.



NOVANT HEALTH EMPLOYMENT


BACKGROUND INFORMATION


INTEREST IN VOLUNTEERING


MEDICAL/PHYSICAL LIMITATIONS


REFERRED TO US BY


AGREEMENT

I hereby state the answers on this application and in any interviews that may follow are true and that any misrepresentation or omission of fact(s), or misleading 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.


I understand that the Volunteer Services Department is not obligated to provide a placement nor are you obligated to accept the position. Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, gender, or sexual orientation.


NOTE: When you click the "Continue" button your application will be submitted to the Volunteer Services Department. Please make sure your application is complete before continuing.