Thank you for your interest in volunteering at Vidant Health. Once you complete the form, click the submit button at the bottom.


You will receive an email telling you the next steps in the process.


Personal Information


Availability


Work & Volunteer Experience


Vidant Health Experience


Work History


Current Enrollment Status


Skills

Please let us know your skills to help us learn more about you. Skills such as retail sales, clerical skills, computer skills, customer service and fluent in Spanish, French, etc. are what we are looking for.


Criminal History

Have you ever been convicted (pleaded guilty or been found guilty) of a misdemeanor or a felony? Provide dates and details for any or all convictions and pending cases below. Including but not limited to major traffic violations, writing bad checks and DUI.
* A conviction does not necessarily disqualify you from volunteering.


Preferences

Share your ideas about specific volunteer placement areas.


Why do you want to be a volunteer?


How did you hear of us?


References


Volunteer Agreement

In submitting and signing this application, I understand that my application will be reviewed by the Manager of Volunteer Services. If I am selected for an interview, I will notified by phone. I understand that this position is not paid and strictly volunteer.

Commitment
* I must provide a minimum of forty (40) hours of service per calendar year. If I am a college or high school student, I must provide to a minimum of at least one semester and thirty (30) hours of service.

* It is my responsibility to get the necessary transportation to and from volunteering.

* I understand that I may be dismissed from my duties for willful wrongdoing or negligence and/or performing duties outside of my service guidelines.

Training/Health
* A volunteer organization and health screening is required before volunteering at Vidant Chowan Hospital.

* All current required immunizations will be given to me unless documented proof is submitted to Occupational Health.

* I must undergo an update of the TB skin test and re-orientation annually.

* Management will follow up with me in a reasonable amount of time to ensure that the placement is satisfactory.

Acknowledgement of Hospital Criminal Record Checks
* Criminal record checks will be performed on every applicant volunteering at Vidant Chowan Hospital

* If the information that I have furnished on this form is found to be false, I could be disqualified/dismissed.

I hereby apply to become a Volunteer at Vidant Chowan Hospital, to abide by my commitment, to keep all patient information strictly confidential, and comply with all rules and regulations. The statements given on this application are true and accurate to the best of my knowledge.

Commitment:
I must provide a minimum of forty (40) hours of service per calendar year.
It is my responsibility to get transportation to and from volunteering.
I understand that I may be dismissed from my duties for willful wrongdoing or negligence and/or performing duties outside my service guidelines.