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Volunteering at hospitals and RTCs

Your time and talents can make all the difference

Thank you for your interest in volunteering at hospitals and residential treatment centers within the Nexus network of care. Please complete the form and we’ll be in touch to find a great volunteer opportunity for you.

Complete the form below for consideration.

Personal Data

MM slash DD slash YYYY
Have you ever been convicted or have you pled guilty or no contest to a felony offense?*
Primary Emergency Contact
Secondary Emergency Contact

Availability

MM slash DD slash YYYY
Which days of the week/time of day works best for your schedule?
Sunday*(Required)
Monday*(Required)
Tuesday*(Required)
Wednesday*(Required)
Thursday*(Required)
Friday*(Required)
Saturday*(Required)
 

Employment and Volunteering History

Start with your present or most recent position.
Company Reference No. 1
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MM slash DD slash YYYY
Company Reference No. 2
MM slash DD slash YYYY
MM slash DD slash YYYY

Education

High School
Did you graduate?*(Required)
College
Did you graduate?*(Required)
Graduate / Professional
Did you graduate?*(Required)
Other
Did you graduate?*(Required)

Professional References

Please provide the name, address and telephone number of three professional references. Exclude those related to you by blood or marriage.
Reference No. 1
Reference No. 2
Reference No. 3
I would like to receive the latest news and updates.
I would you like to be put in contact with a Nexus team member.

Applicant's Statement

I certify that all my answers given herein are true and complete. I understand that any misrepresentation or material omission that was made by me on thi sapplication will be sufficient cause for cancellation of this application, or immediate discharge, regardless of when it is discovered.

I fully authorize investigation of all statements contained within this application as may be necessary. I fully and completely RELEASE the facility, its owners and employees, and all previous employers and their employees, from any liability related to inquiries or responses made on my behalf and I request all prior employers, schools, governmental offices, and all other references included on this application, provide full and timely disclosures on my behalf.

I acknowledge that a criminal history background check may be conducted on me as a part of the application process, and I understand that my authorization used above may be used in obtaining information regarding any prior convictions.

Finally, I also understand that if I volunteer, I will be required to provide proof of my identity within 3 days from my start date.

I represent and warrant that I have read and fully understand the foregoing and seek to volunteer under these conditions.

Accept all terms and conditions to submit form.

*Required
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