Volunteer Application | Nexus Health Systems

Personal Data

Full Name*

Hidden

Street Address Address Line 2 City State ZIP Code

Email*

How Were You Referred To Our Company?**

Employee
Walk-In
Friend
Other

Availability

What date would you be available to start volunteering?**

Sunday**

Morning
Afternoon
Evening
None

Monday**

Morning
Afternoon
Evening
None

Tuesday**

Morning
Afternoon
Evening
None

Wednesday**

Morning
Afternoon
Evening
None

Thursday**

Morning
Afternoon
Evening
None

Friday**

Morning
Afternoon
Evening
None

Saturday**

Morning
Afternoon
Evening
None

Do you have any friends or relatives working or volunteering for this facility?**

Have You Ever Been Convicted Or Have You Pled Guilty Or No Contest To A Felony Offense?**

Yes
No

Please list any emergency contacts:**

Please explain why you want to volunteer at our company:**

Do You Speak, Read Or Write In Any Language Other Than English?**

Yes
No

Employment And Volunteering History.

Start with your present or most recent position.

Company Reference #1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Reference #2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Reference #3

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Education

High School

Did you graduate?**

Yes
No

College

Did you graduate?**

Yes
No

Graduate/Professional

Did you graduate?**

Yes
No

Other

Did you graduate?**

Yes
No

Professional References

Please provide the name, address and telephone number of 3 professional references. Exclude those related to you by blood or marriage.

Reference #1

Reference #2

Reference #3

eNews Signup

Yes, I would like to receive the latest news and updates.

Would you like to be put in contact with a Nexus team member?

Yes
No

If so, do you prefer

Email
Phone

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 thisapplication 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.

Name

This field is for validation purposes and should be left unchanged.

Volunteer at Nexus

Personal Data

Availability

Employment And Volunteering History.

Company Reference #1

Company Reference #2

Company Reference #3

Education

High School

College

Graduate/Professional

Other

Professional References

Reference #1

Reference #2

Reference #3

Interested in volunteering at a Nexus Health Systems' Facility?