Volunteer Application

  • Please fill in the following application and hit "Submit" at the bottom of the application to send it to New Hope Clinic. A NHC representative will contact you shortly after receiving the application.
  • Please list two references

    1. 1. I certify that my answers on this application are true.
    2. 2. I authorize New Hope Clinic to verify the information submitted in this application and to contact the references provided.
    3. 3. If accepted as a volunteer at New Hope Clinic, I agree to abide by the rules and regulations of New Hope Clinic, Inc.
    4. 4. My services are donated without contemplation of compensation or future employment.
    5. 5. I shall not solicit any business for attorneys or insurance companies “for compensation”, both on or off Clinic property, or act as a runner for an attorney in the solicitation business. I shall report all known occurrences of solicitation for attorneys.
    6. 6. I shall not sell or attempt to sell goods or services, request contributions, or solicit persons to sign or distribute political petitions on Clinic premises.
    7. 7. I shall attempt to resolve any problems related to my volunteer activities with the New Hope Clinic Executive Director.
    8. 8. I understand that the Clinic reserves the right to terminate my volunteer status as a result of (a) failure to comply with Clinic policies, rules and regulations; (b) absences without prior notification; (c) unsatisfactory attitude, work, or appearance; or (d) any other circumstances which, in the judgment of the Executive Director, Medical Director, Dental Director, or Pharmacy Director, would make my continued service as a volunteer contrary to the best interests of the Clinic.