Adult/College Volunteer Application - Kernersville Medical Center
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 email@example.com.
NAME AND CONTACT INFORMATION
Legal first name:
OK to call me here
OK to call me here
OK to call me here
Date of birth:
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 firstname.lastname@example.org.)
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, CORE VALUES
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 5 Core Values are:
* PERSONAL EXCELLENCE
* DIVERSITY & INCLUSION
Choose the one that stands out the most to you and explain what it means to you.
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.
What volunteer categories interest you?:
Greeting and Wayfinding
Unsure at this time
Waiting Room (i.e., ICU, Surgery, etc.)
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
How did you hear about this program?:
Live in the area
Newsletter or flyer
Novant Health employee
Novant Health volunteer
Online or Social Media
FRIEND OR RELATIVE EMPLOYED BY NOVANT HEALTH
Friend/Relative employed by Novant?:
IF YES, please provide name(s) of friend/relative.
Please indicate the day(s) and time(s) you are available to volunteer.
5am - 8am:
8am - 12noon:
12noon - 4pm:
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.