Please complete this application form if you are interested in becoming a WellStar West Georgia Medical Center Volunteer. Once you complete the form, click the submit button at the bottom.


General Information


Previous Volunteer Experience

Have you ever been a volunteer? Please check yes or no.



Emergency Contact

Please list your Emergency Contact person.




Hobbies, Talents and Other Responsibilities


Availability

Our usual shifts are morning or afternoon shifts. The Volunteer usually works one shift of four hours per week. What days and hours are you available for regular service?





Educational Background


References

These should be a member of the WWGMC Auxiliary, a Physician, clergy or other respected member of the community.



Background Screening

Have you ever been convicted of a criminal offense other than a minor traffic violation? Please check yes or no.



Agreement

WellStar West Georgia Medical Center is committed to maintaining a healthy environment and is a tobacco/smoke- free facility. Policy prohibits use of tobacco in any area of the Health System.


Your signature indicates your approval for us to check references and contact your physician regarding your physical and emotional health. WWGMC is not obligated to provide a placement, nor are you obligated to accept the position offered. Opportunities for volunteers are provided without regard to race, color, religion, sex, citizenship, national origin, age, or disability.