• Nurses and Clinical Support Volunteer Application – Volunteers in Medicine

    Apply to join our team as a Nurse or Licensed Clinical Support Volunteer. Please complete all sections of this application so we can best match your skills, experience, and interests to the clinic's needs. Please note: Nurses may volunteer at VIM as intake specialists even if they do not currently hold an active South Carolina nursing license.

  • Personal Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Professional Information

  • License Expiration Date*
     - -

  • Employment History

  • Current Practice Status*
  • Clinical Volunteer Interests*

  • Availability

  • Days Available*
  • Volunteer Frequency*

  • Credentials Upload

  • Upload a File
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    Cancelof
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof

  • References

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Background & Compliance

  • Has your professional license ever been suspended?*
  • Do you agree to a background check?*
  • Have you completed HIPAA training?*
  • Have you completed orientation?*
  • Have you completed EMR training?*

  • Statement of Interest

  • Agreement & Electronic Signature

  • Date*
     - -
  • Should be Empty: