Adult Volunteer Application

  

Desired Volunteer Location:

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Please select your desired volunteer location(s):

Greenville Memorial Medical Campus

  • Cancer Center
  • Center for Family Medicine
  • Corporate Services
  • Cross Creek Surgery Center
  • Greenville Memorial Hospital
  • Life Center
  • Marshall I. Pickens Hospital
  • Medical Center Clinics
  • Medical Offices
  • Roger C. Peace Hospital

701 Grove Road Greenville, SC 29605
(864) 455-7994 fax: (864) 455-4182

Greer Medical Campus

  • Greer Memorial Hospital
  • Cottages at Brushy Creek)

830 S. Buncombe Road Greer, SC 29650
(864) 797-8072 (864) 797-8078 fax

Patewood Medical Campus

  • Gardens at Eastside
  • Medical Offices
  • Outpatient Services
  • Patewood Memorial Hospital

175 Patewood Drive Greenville, SC 29615
(864) 797-0112 (864) 797-0107 fax

Simpsonville Medical Campus

  • Hillcrest Memorial Hospital
  • Medical Offices

729 SE Main Street Simpsonville, SC 29681
(864) 454-6179 (864) 454-6116 fax

North Greenville Medical Campus

  • Medical Offices
  • North Greenville Hospital

807 North Main Street Travelers Rest, SC 29690
(864) 455-9259 (864) 834-5719 fax

Laurens County Memorial Medical Campus

22725 U.S. 76, Clinton, SC 29325
(864) 833-9100






Community Acitivites/Volunteer Information

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Prior Hospital Experience?

When/Where?
Other volunteer experience:
Community Affiliations:
Additional information:

(if applicable)

Preferred work area(s):

Preferred Work Times

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Morning






Afternoon






Evening






Personal Information

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First Name
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MI
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Last Name
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Address 1
Address 2
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City
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State
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ZIP
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Home Phone
Work Phone
Cell Phone
Email Address
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Emergency Contact Name
Emergency Contact Phone
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Education/Special Training
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Work Experience
Skills/Hobbies/Special Interests
Special Communication Skills

(i.e. Sign language, fluency in foreign languages)

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Have you ever been convicted of a crime other than a minor traffic violation?

If yes, provide details:

Personal References

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Reference Name - Three references required - note that references need to be non-family members.
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Reference Address
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Reference City
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Reference State
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Reference Zip
Reference Email
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Reference Phone
Reference Fax
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Reference Name (not a family member)
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Reference Address
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Reference City
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Reference State
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Reference ZIP
Reference Email
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Reference Phone
Reference Fax
Reference Name (not a family member)
Reference Address
Reference City
Reference State
Reference ZIP
Reference Phone
Reference Email

Statement of Understanding

I hereby give the Greenville Health System permission to contact the listed references and release the Greenville Health System from any liability as a result of such contact. I understand that volunteer placement will be contingent upon receipt of satisfactory references and a personal interview, a physician’s release, completion of all initial and future health requirements as prescribed by the Greenville Health System’s Employee Health Department, a criminal background check, and completion of orientation and training requirements.