General Volunteer Application

General Volunteer Application
Thank you for your interest in Hope Clinic of Ross County. This application, completion of orientation and a background check are required to be considered as a volunteer. Your background check can be obtained at https://hopeclinicofrosscountyinc.quickapp.pro/apply/applicant/new/17347. If you have any questions, please contact us at hopeclinic@hopeclinicfree.org.
I am a new volunteerI am a current volunteer applying per the bi-annual recertification requirements
Contact Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Phone Number*
Mobile Device?*

YesNo
Work Number?*

YesNo
Secondary Phone Number
Mobile Device?

YesNo
Work Number?

YesNo
Email Address*
Personal Information
Birth Date*
How did you hear about Hope Clinic of Ross County?*
Have you ever been convicted of a crime?*

YesNo
If yes, please explain. If no, please type N/A*
If you are bilingual, what is your second language?
I am interested in serving in the following areas:*

AdministrationData EntryEvent PlanningFundraisingGrant WritingHospitalityITJanitorialLaboratory TechnicianMaintenancePatient NavigatorPrayer TeamOtherWhere Needed
Do you have any skills/experience you think would be useful at Hope Clinic?
Reference #1
Name*

First NameLast Name
Primary Phone*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Relationship*
Reference #2
Name*

First NameLast Name
Primary Phone*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Relationship*
Acknowledgement/Agreement
At Hope Clinic we desire to treat our patients, volunteers and guests as we would want to be treated. We value volunteers who are kind compassionate, caring and non-judgmental. Every human has a story and not every story is the same. This is why we strive to genuinely care for the needs of others and remind them that we want to share their burden and improve their health in as many ways as we can. We want to reserve judgment about WHY there is a need and focus our time and talents on MEETING THAT NEED. We pray that our clinic could be the hands and feet of Jesus in our community. While volunteering at Hope Clinic I will conduct myself with these values in mind. I also understand that by submitting this form I attest the information I have provided is true and accurate and that completing this application does not automatically register me as a Hope Clinic volunteer.*

Agree
Should be Empty:

General Volunteer Application

Contact Information

Personal Information

Reference #1

Reference #2

Acknowledgement/Agreement