Volunteer Services: Auxiliary Volunteer Program
Auxiliary Volunteer Program

Please complete the application below and press the SUBMIT button when complete.

General Information
Name  
Address:
City & Zip:
Gender:
Date of Birth:
Home Number:
Work Number:
E-mail Address:  
Fax Number:
Are you presently employed or enrolled at a school or university? If so, where:
 
Have you ever been convicted of a DUI or any other crime (other than a minor traffic violation)?
If Yes, explain:
 
How did you hear about the Volunteer Program at DeKalb Medical?
 
Will volunteering fulfill a community service or school requirement? If yes, please explain:
 
Work Experience
As a volunteer:
 
As a paid employee:
 
Any special training:
 
Intrests/Skills
Please list any special skills or talents you would like to share. Example: typing or computer knowledge.:
 
Foreign Languages:
 
What are your reason(s) for you wanting to become a volunteer at DeKalb Medical:
 
Auxiliary Volunteer Program Requirements
  • Interview with a member of the Volunteer Services staff.
  • Submit a criminal background check release form at time of interview.
  • Take a two step Tuberculosis test after accepted to program.
  • Commit to a minimum of one year service and 9 hours a month.
  • Attend a two-hour Volunteer In-service and Auxiliary orientation.
  • Select a specific weekly or bi-weekly service area and volunteer schedule.
  • Purchase a volunteer uniform, available in Volunteer Office for $15.
  • Pay Auxiliary yearly dues of $15.
Required
Name of your personal physician:
Physician's phone number:
Physician's fax number:
Do you give permission for us to contact your physician?:
Hospital Preference



Agreement
  • By submitting this application, I hereby certify that the answers on this application are true and correct and that any misrepresentation or omission of facts, misleading or false information on my part will be grounds for dismissal as a volunteer.
  • I understand that it is my responsibility to learn, understand and abide by all policies and rules of DeKalb Medical, whether they are written or unwritten, and that failure to abide by the policies and rules is cause for discharge.
  • Acceptance as a volunteer is contingent upon satisfactory references, physician approval and verification of the information submitted on this application. I therefore authorize you to make such investigations and inquiries, regarding my employment history, work references, criminal background and others, as you deem necessary in arriving at a decision to accept me as a volunteer.
  • I authorize that all employers; schools or references thus contacted should be released from all liability in answering inquiries related to my application.
The Volunteer Services Department is not obligated to utilize your services as a volunteer nor are you obligated to accept the volunteer assignment offered.
Confirm Identity


DeKalb Medical now includes:
DeKalb Medical at North Decatur
DeKalb Medical at Hillandale
DeKalb Medical at Downtown Decatur
DeKalb Medical
2701 North Decatur Road
Decatur, GA 30033
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Patient Information - 404.501.5200

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