West Georgia Health LaGrange GA - Become a Volunteer at West Georgia Health

Careers

Become a Volunteer at West Georgia Health

Use the online form below to submit your application electronically. Alternately, you can download a printable application (in PDF format), complete and mail it to:

Jean Cook
Director of Volunteer and Community Services
1514 Vernon Road
LaGrange, GA 30240
706-845-3965

PERSONAL INFORMATION ( * indicates required field ) First Name * Last Name * Address * City * State * Zip Code * Phone * E-mail Birth Date * Spouse's First Name Emergency Contact Emergency Phone Name of Physician * Physician Phone *

EDUCATION ( * indicates required field )

Please select your highest level of education. *

High School Diploma

Associate's Degree

Bachelor's Degree

Master's Degree

Other

Please provide any additional details that will assist us in understanding your educational background such as school, years attended, etc.

OTHER EXPERIENCE, INTERESTS AND TALENTS Other professional or business experience? What are your hobbies and talents? What are your other responsibilities? (small children, job, other volunteering, etc.)

VOLUNTEERING ( * indicates required field ) Have you ever been a volunteer? * If so, tell us about your volunteering experience. Do you have a preference for the type of volunteer service placement? * Our usual shifts are 9:00 a.m. to 1:00 p.m., from 1:00 p.m. to 5 p.m., and from 5:00 p.m. to 8:00 p.m. The volunteer usually works one shift of four hours per week. What days and hours are you available for regular service? *

REFERENCES

References should be a member of the WGHS Auxiliary, a physician, clergy or other respected member of the community.

First Name (#1) Last Name Address City State Zip Code Phone E-mail First Name (#2) Last Name Address City State Zip Code Phone E-mail

BACKGROUND ( * indicates required field ) Have you ever been convicted of a criminal offense other than a minor traffic violation? * If yes, please give all of the facts regarding your conviction.
Note: A conviction will not automatically disqualify you from a placement.

West Georgia Health is committed to maintaining a healthy environment and is a tobacco/smoke-free facility. Policy prohibits use of tobacco in any area of West Georgia Health.

Checking "I agree" below indicates your approval for us to check references and contact your physician regarding your physical and emotional health.

I agree to the above terms. *

West Georgia Health is not obligated to provide a placement, nor are you obligated to accept the position offered. Opportunities for volunteers are provided without regard to race, color, religion, sex, citizenship, national origin, age, or disability.