PLEASE READ CAREFULLY

I certify that the facts stated on this application are true and complete to the best of my knowledge, and I hereby grant High Point Regional Health System permission to verify all such information and I understand that any false statement, misrepresentation or omission of facts on this application may result in rejection of the application for further volunteer work consideration or my immediate dismissal if discovered subsequent to my volunteer position acceptance. I further agree that the Health System shall not be liable in any respect if my volunteer position is terminated because of any false statement, misrepresentation or omission of facts made by me in connection to this application.

I understand that the information this application will be checked , that a background check will occur, and previous employers will be contracted for the purposes for the purpose of verifying the information contained herein. I hereby grant the Health System permission to perform a background check , to check my references and to verify the information contained in my application. Further, I authorize my former employers, personal references and others to give my information concerning me requested by the Health System, whether or not it is in their records, and I hereby release them and their companies from any liability whatsoever.

If offered a volunteer position by the Health System, I understand and agree to submit to a medical examination and any future medical examination required by the Health System. Part of this examination includes drug testing and I understand I must submit a sample of my urine and/or blood for chemical analysis to determine the presence of illegal or non-prescription drugs in my system. Further, I understand that the presence of any illegal drug will result in denial of a volunteer position with High Point Regional Health System.

I understand that this application for volunteer work in no way obligates this Health System to accept me for a volunteer position. However, should I obtain a volunteer position, I agree to comply with all guidelines, rules and regulations established by the Health System. Further, I understand and agree that my volunteer position is for no definite period and may, regardless of the date of my acceptance, be terminated at any time without previous notice to me.

Background check will include criminal history.