NOVUS Health Volunteer Application Form

NOVUS Health

Volunteer Application Form
Thank you for your interest in volunteering with Novus Health. Please complete the application below. Once your application is reviewed, we will reach out to schedule an orientation meeting.
Name*

First NameMiddle NameLast Name
Email
example@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth (If under 18 will require waiver from parent/guardian)*

MonthDayYear
Date
In which areas would you like to volunteer?*

Outreach/EventsAssist patients in Food PantryFront DeskPick up or deliver foodStock Food PantryOther
Tell us some about your skills! (e.g., good at working with people, advanced computer skills, clinical experience, studied nutrition, etc)*
Please provide your availability*
Preferred method of contact:

PhoneEmail
Do you have a drivers license?*

YesNoI have a CDL!
Have you ever been convicted of or pleaded guilty to a felony or misdemeanor?*

YesNo
Date*

MonthDayYear
Date
Signature*
Should be Empty: