First name*Middle nameLast name*Street 1*Street 2Street 3City*State*Zip*Best contact numberHomeWorkCellCell phone*Home phoneWork phoneEmail*Date of birth*EducationHIgh SchoolSome CollegeAssociate DegreeVocational/Trade SchoolCollege DegreeMaster’s DegreeDoctoral DegreePosition(s) for which you’re applying (check all that apply):Administrative Support [Volunteer Services]Applicants [Medical Clinic]Clerical/Office [Medical Clinic]Clinical Assistants [Medical Clinic]Communications (e.g. newsletter, social media, website) [Volunteer Services]Electronic Medical Records Assistant [Medical Clinic]Front Desk, Medical [Medical Clinic]Fundraising (e.g. events, mailings) [Volunteer Services]Interpreter (Spanish) [Medical Clinic]Medical Providers [Medical Clinic]Volunteer Coordinator [Volunteer Services]Available days to volunteerMondayTuesdayWednesdayThursdayFridaySaturdayAvailable times to volunteerMorningAfternoonEveningVaried timeDo you have particular experience or skills to share? What motivates you to volunteer?Is there anything else we should know about you?I assert that the information I have provided is accurate to the best of my knowledge. Also, I agree that I will provide Employment, Emergency, Full Disclosure (criminal background), and Reference information. If I am accepted as a volunteer worker for the Savie Health Free Clinic, I will abide by their policies and procedures, attend an orientation session prior to my first day worked, submit verification of recent health examination conducted by a physician, and agree to have an annual TB test.*Submit Please enable JavaScript in your browser to submit the form
