WellStar Medical Center Volunteer Application

Please complete this application form if you are interested in becoming a WellStar Atlanta Medical

Center volunteer. We have a minimum age requirement of 18. Once you complete the form, click the submit button at the bottom. Complete a Volunteer Medical Release Form. It has to be printed and must be filled out and signed by a licensed Physician or Nurse Practitioner. (The form is available on the Volunteer page where the application link is located.) Also if you were born after 1957, an immunization record must be submitted.


Contact Information


Skills & Experience

Please tell us why you would like to volunteer at WellStar Atlanta Medical Center. Also, please provide a brief description of your relevant skills and experience that may assist us in determining what placement will best fit your skills.



Availability

Please indicate the days and times you are usually available to volunteer.



Assignment Preference

Please list the areas you would like to work in. Some of the areas available are: Reception Desk, Gift Shop, Patient Support, Clerical and Fundraising.



Emergency Contact

In the event of an emergency whom should we notify?



Employment

Are you currently seeking employment? If so explain.



Employer

Please list your current or most recent employer, if applicable.



Schooling

Are you presently in School? If so what school and what is your major? Is volunteering a requirement?



Transportation

Do you own a car? If not what type of transportation would you use to get to your assignments?



WellStar

Have you ever been employed or volunteered at WellStar? If yes where and when.



Language

What is your primary language? If you have a secondary language please list it.



Convicted of a Felony?

Have you every been convicted of a Felony? If yes please explain.



I Agree

I understand and agree that submitting this application form does not automatically register me as a WellStar Atlanta Medical Center volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering. We consider the safety and security of our patients, visitors, staff and volunteers to be of the utmost importance.


Applicant must sign a release for a Background History screening for criminal background histories by state and federal agencies. Persons who have been convicted of any felony offense or misdemeanor offenses involving drugs, child abuse, assault, and/or any violent behavior are not eligible to volunteer in our program. THERE ARE NO EXCEPTIONS.


REMINDER: The Volunteer Medical Release Form has to be printed and must be filled out and signed by a licensed Physician or Nurse Practitioner. (The form is available on the Volunteer page where the application link is located.) Also if you were born after 1957, an immunization record must be submitted. NO MEDICAL RECORDS WILL BE RETURNED AND ALL WILL REMAIN THE PROPERTY OF THE WELLSTAR ATLATNA MEDICAL CENTER VOLUNTEER SERVICES.


By submitting this form, I attest that the information I have provided on the form and the documents forwarded in addition to the application are true and accurate.