Volunteer Application

Volunteer form
Are you 18 years of age or older?
Have you lived in North Carolina the last 5 consecutive years?
Have you ever volunteered or been employed here before?
Schedule preferred
Shift preferred


Please provide school name, location, major, and GED/Diploma/Degree earned for each of the schools you attended.

Prior Employment

(start with most recent employer)

Prior Employment - Employer 2

Prior Employment - Employer 3

Military Service

Personal References

Personal References

Personal References

The above information is true and complete to the best of my knowledge. Should I be a volunteer at Granville Health System, any misrepresentation or false statement contained herein may be considered cause for possible dismissal. Granville Health System has my permission to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history, and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice to me. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to Granville Health System. I understand this application does not constitute a volunteer contract of any kind. Should I volunteer at Granville Health System, I may resign at any time at my discretion with or without prior notice and Granville Health System may terminate my volunteer services at any time at their discretion, with or without cause and with or without prior notice. I understand I am applying for a position at a tobacco-free facility that does not permit smoking and the use of tobacco products in the building, on the grounds, or in the parking areas of any owned and leased property of Granville Health System.

If you agree with the above statement, please check "Agree"