Dear Prospective Volunteer:

Thank you for your interest in volunteering at Atrium Health Union. Volunteers are an important part of our team that make a difference in the lives of our patients and their loved ones.

We require our volunteers to be 15 years of age or older and ask for them to commit to a minimum of 50 hours of service, preferably working the same shift/position each week. We offer volunteers many opportunities to choose from in giving of your valuable time.

If you feel you will be able to meet the requirements above please complete this application form if you are interested in becoming a Atrium Health Union volunteer. Once you complete the form, click the submit button at the bottom. You will receive a confirmation email after submission. Please contact me within 2 weeks of receiving this confirmation for a phone interview. At that time you will be given the process to become a GREAT Volunteer with our facility.

Name and Contact Information


Responsible Person

Please list a responsible person whom we may call should there be a need (list parent if under 18)


Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.


References

Please list two reference we may contact. (Do not use relatives or current Atrium Health Union teammates)


Availablity and Volunteer Interests

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


Why do you wish to volunteer?

Indicate reason why you would like to volunteer with Atrium Health Union.


Employment with Atrium Health Union

Are you now or have you ever been employed by any Atrium Health Union facility? If so, where and when.


TB Tests

If you are 18 years or less, please have a parent/guardian accompany you when you receive your TB skin test which is a requirement of your volunteer experience.


Site Preference

Please indicate which site you would most like to volunteer at in the space provided below:

Atrium Health Union
600 Hospital Drive
Monroe, NC 28112

Atrium Health Waxhaw
2700 Providence Road South
Waxhaw, NC 28173


Charges and Convictions

Arrest and conviction records are obtained on all applicants over 18 years old. An arrest or conviction will not automatically eliminate you from consideration for volunteering. However, failure to list below all pending charges and/or convictions may lead to your disqualification or termination of volunteering with Atrium Health Union.

Please list below any convictions of any criminal violation of law, or any pending investigations or charges of violation of criminal law. Examples may include, but should not be limited to: Driving while impaired, worthless checks, assault, driving while license is suspended, disorderly conduct, credit card fraud, embezzlement, etc.
Indicte "none" if this does not apply.

If required, please indicate number of hours of court ordered community volunteer service that you will need to complete. Indicate "none" if this does not apply.


I hereby affirm:

I hereby affirm that the information provided on this application is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for the volunteer program and may result is discharge even if discovered at a later date.


Thank You and Signature

Thank you for your application and reference. It must be submitted to Atrium Health Union before an orientation will be scheduled.
Your signature indicates your approval for us to check references. Submitting an application does not assure volunteer placement since the number of applicants usually exceeds the number of available opportunities. Volunteer Services is not obligated to provide placement, nor are you obligated to accept the position offered. All applications are held for 90 days.

Signature in Commment Section.


Volunteer Agreement

As a volunteer I agree:

I will consider as confidential all information which I may hear or see, directly or indirectly, concerning a patient, Patient family member, doctor or other health care professional and I will not seek information for any of the above in regard to a patient.