Adult Volunteer Application
First Name
*
Last Name
*
Phone
*
Email
*
Street Address 1
*
Street Address 2
City
*
State
*
Please Select
Select State
Alabama
Alaska
Arizona
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District of Columbia
Delaware
Florida
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Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
Previous Affiliation
Are you currently or were you previously an employee of Cape Fear ValleyHealth System?:
Yes
No
Are you currently a contracted staff member working on any of the CapeFear Valley Health campuses or sites?
Yes
No
Do you have any family members or relatives that are current employee or contracted staff members at Cape Fear Valley Health System?:
Yes
No
Are you currently or have you previously served in the United States Armed Servies?:
Yes
No
Background
Have you ever been convicted of a crime other than minor traffic including a misdemeanor or felony? **Examples may include, but not limited to: Driving under the influence; worthless checks; assault; disorderly conduct; credit card fraud; embezzlement, etc. **A conviction record will not necessarily be a ban to employment.:
Yes
No
Volunteer Location/Facilites
Indicate with checkmarks facilities/programs with which you would prefer to volunteer:
Patient Family Advisory Council
Cape Fear Valley Medical Center
Highsmith-Rainey Memorial Hospital
Cancer Center
Southeastern Regional Rehab Center
NICU/Cuddler Program
NODA (No One Dies Alone)
Pastoral Care
Behavioral Health Care
Pediatrics
Blood Donor Center
Pet Therapy
CFVHS Outpatient Clinics
Gift Shop - Hoke Hospital
Volunteer Experience
Do you have any previous volunteer experience?
Yes
No
Please Read and Submit
By completing this application, I hereby certify that the information given is fully and correctly answered. I understand that any misrepresentation, omission, or misstatement, whether intentional or not, is grounds for rejection of my application or termination of my volunteer position if such an occurrence is discovered at a later date. If, in the judgment of Cape Fear Valley Health System (the “Health System”), any information contained herein is found to be untrue, incorrect, or incomplete, I understand that I may be refused a volunteer position or subject to immediate dismissal if already volunteering.I understand that should I be offered a volunteer position by the Health System; my volunteer position thereafter may be terminated with or without cause or with or without notice at any time, at the option of either the Health System or myself. I understand that no representative of the Health System has authority to enter into an agreement with me for a volunteer position for any specified period of time, or to make any agreement with me contrary to the foregoingand certify that no representative has done so. Cape Fear Valley Health System is an Equal Opportunity/Affirmative Action Employer. All decisions are based on individual qualifications, without regard to race, color, sex, national origin, age, religious belief, or disability.CONSENTI voluntarily authorize the Health System to investigate all information contained in this application. If offered a volunteer position, I agree to abide by all present and subsequently issued or revised Health System policies. I agree to submit to any physical examination as required by the Health System as a condition of volunteering. I understand that if I am selected for a position at the Health System, a drug test will be administered prior to the start of my employment, and that a positive test outcome will result in withdrawal of the volunteer position offer. I further understand that a background check (criminal and regulatory) will be conducted and reviewed by the health system. I consent to both the drug test and background check being performed prior to, and as a condition of volunteering.*
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