Volunteers
Become a Volunteer!
Our Volunteers make a difference in the lives of patients, residents and their families. Our Volunteers develop creativity, meet new people, explore new careers and grow personally.
Application Procedures
Complete the Auxiliary Volunteer Application
- Need Name, Address, City State, Zip, Date of Birth
- Occupation - Volunteer
- Social Security # optional on this form.
- Area of Service Ex. Beauty Shop, Canteen, Candy Cart, Mail
- Sign and Date
Background Information Disclosure
- First Line - First Name and Middle Name, Last Name
- Second Line - Maiden Name, Birthrate, Gender, Race
- Third Line - Address, Social Security # (required on this form)
- Business Name and Address - RCMHNH
- Complete Yes/No questions front and back
- Sign and Date
Complete the Health Certificate Form
- Need Name, Address, Date of Birth
- Social Security # optional on this form
- Emergency Contact Person, Address, Phone #, and Relationship
- Physician Name, Phone #
- Complete Health History, Allergies
- Sign and Date
Then, take the form to the hospital nurse's station or Infection Control for the T.B. skin test. Remember the T.B. test must be read by the nurse two days later. You will not be charged for these tests. Keep the Health Certificate Form and bring back for the nurse to sign two days later.
Complete the Volunteer Confidentiality Statement
- Print Name
- Sign and Date
- Department - Activity/Volunteer
You must have 2 references - from a friend, co-worker, minister, or any person that knows you very well, but not a relative. If you have a job you will need one from your employer. Please print out and follow instructions below.
- Provide Name of Reference for each form
- Print Name in name of applicant section on both forms
- Sign and Date both forms.
It is up to you to give the reference form, and the stamped envelope to each person you ask for a reference.
Thank you for your cooperation,
Melissa Dixon, MT-BC, Activity Director