Volunteer Application

Volunteer Application
Contact Information
Name*

PrefixFirst NameMiddle NameLast Name
Preferred Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Email*
example@example.com

Emergency Contact Information

Please let us know who to contact in the event of an emergency.
Name*

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

References

List two personal references including a former employer, if applicable. Please exclude relatives.
First Reference:
Name*

First NameLast Name
Company
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Relationship*
Second Reference:
Name*

First NameLast Name
Company
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Relationship*

Auxiliary Membership
Northeast Georgia Health System Auxiliary is led by a board of Health System volunteers and designated Health System Management as ex-officio members. Board members are elected by the Auxiliary’s Nominating Committee and approved by the Auxiliary Membership.

Membership dues are a minimum of $25 per year. The Health System Auxiliary donates funds generated through volunteer efforts and Auxiliary projects to Northeast Georgia Health System Foundation to enhance services of Northeast Georgia Health System. To join the Auxiliary, go to nghs.com/medical-center-auxiliary.
Background Check

Once you submit your application, you will receive a confirmation email with information regarding your background check. You must complete your background check before this application will be accepted.
I understand that upon receiving my application confirmation email, I must follow the directions to complete my background check before this application will be considered.*

YesNo
Agreement & Signature
I understand that volunteer applicants of Northeast Georgia Health System must fulfill all Volunteer Services requirements, including completion of application, interview, tuberculosis test, proof of MMR/Varicella, fully vaccinated against COVID-19, and current flu shot.

I authorize Northeast Georgia Health System to check any references requested and to perform a criminal background check for the purpose of acquiring reference in-formation, and I release the Health System from any liability based on such releases.

I also certify the application information is accurate and complete and that the Health System may accept volunteers in its sole discretion and may release a volunteer at any time from serving the organization.
By typing your name below and submitting this form, you indicate agreement to the statements above.*
I acknowledge that I am submitting my personal information to NGHS, which will be used in accordance to the NGHS Online Privacy Statement.*

I agree
View the NGHS Online Patient Privacy Statement
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Wednesday
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Saturday
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Volunteer Application

Contact Information

Volunteer Information

Emergency Contact Information

References

Schedule Availability

Areas of Interest

Skills/Hobbies/Experience

Auxiliary Membership

Background Check

Agreement & Signature