1. society
2. welfare
3. healthcare
4. hospital

How do you become a Raulerson Hospital
Volunteer or Volunteen?
Thank you for your interest in becoming a Volunteer or Volunteen member of the
Raulerson Hospital Auxiliary. The following process is required for all applicants:
1. Submit a Volunteer/Volunteen application to the Auxiliary President or Auxiliary
Coordinator who will contact you to schedule an interview.
2. Participate in an interview with Auxiliary Leadership. When your interview has been
completed, you will be required to sign the Consumer Authorization for a Criminal
Background Screening. (Please be advised Raulerson Hospital conducts a criminal
background investigation on all applicants).
3. Upon receipt of the approved criminal background screening, you will be asked to
complete a PPD health screening (used to diagnose Tuberculosis/TB) through our
Company Care department. You will be required to return to Company Care within 2-3
days to have the results of your PPD Screening read. Flu vaccines are also available for
our Volunteers/Volunteens at no cost.
4. Provide your size for your Auxiliary Uniform (pink scrub top for women/blue polo shirt
for men). Auxiliary members are responsible for the purchase and cost of white uniform
pants/slacks.
5. Attend Raulerson Hospital’s New Employee Orientation program prior to beginning their
service:
o Orientation begins at 7:30 a.m. and ends by 4 p.m.
o Orientation is held in the Inservice Classroom, located in the annex building
behind/the hospital. Follow the signs in the parking lot.
o Lunch will be provided.
o Bring a sweater or jacket.
______________________________________________________________________________
Contact Information
Robin Arrieta, Volunteer Coordinator:
[email protected]
(Phone) 863-824-2760/ (fax) 863-824-2991
Raulerson Hospital Auxiliary President:
Arlene Lester Baker
(Phone) 863-697-8174
RAULERSON HOSPITAL VOLUNTEER APPLICATION
Name________________________________________________Date of Birth________________________________________
Last
First
Middle
Mo/Day/Year
Current Address__________________________________________________________________________________________
City_______________________________________State____________________Zip__________________________________
Home Phone______________________________________Work Phone____________________________________________
Place of Employment_____________________________________________________________________________________
Address________________________________________________________________________________________________
City___________________________________________State___________________Zip______________________________
Current responsibilities and hours__________________________________________________________________________
Previous Employment (In last five years)
Dates
Employer
Address/Phone
Position Supervisor
Reason for Leaving
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Past Residences (In last five years)
_______________________________________________________________________________________________________
Address
City
State
Zip
_______________________________________________________________________________________________________
Address
City
State
Zip
Education:
Years
School
Major Subjects
Degree
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Please list any Special Skills, Training, Hobbies_________________________________________________________________
Community Affiliations____________________________________________________________________________________
Previous Volunteer Experience:
Dates
Organization
Address Description of Duties
Supervisor/Phone
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Can you make a commitment to this program for six months?

 No
Yes
If no, please explain_______________________________________________________________________________________
Winter resident:  Yes  No
Permanent resident:
 Yes
 No
How many hours per week are you willing to volunteer?___________________________________________________________
Hours Preferred: Morning 8-12am
Afternoon 12-4pm
Evening 4-8pm
Services available to volunteer workers (Circle your preferences)
1. Gift Shop 2. Lobby & Escort Messenger 3. Filing
Have you been convicted of a crime and/or released from confinement following a conviction for any criminal offense?
Yes
No
If yes, give date, place and nature of each such conviction.
________________________________________________________________________________________________________
Are you presently charged with any violation of the law?
If yes, give date, place and nature of each such charge.
Yes
No
________________________________________________________________________________________________________
References (Please list three people who know you well and can attest to your character, skill, and dependability, DO NOT
include relatives.)
Name
Occupation
Address
City
State
Zip
Phone
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Why do you want to be a Volunteer?_________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
I authorize investigation of all statements herein and release Raulerson Hospital & Auxiliary and all others from liability in
connection with the same. I understand that untrue, misleading, or omitted information herein may result in dismissal, regardless
of the time of discovery.
Signature_________________________________________________________Date__________________________________
Aux Application: 6/97; 1/99; 7/02; 4/05
CONSUMER AUTHORIZATION
I. I understand that an investigative report may be generated on me that may include information as to my character, general reputation, personal
characteristics, or mode of living; work habits, performance or experience, along with reasons for termination of past employment/professional license or
credentials; education; financial/credit history; or criminal/civil/driving record history. I understand that General Information Services, Inc. (GIS), on
behalf of HCA or one of its affiliates may be requesting information from public and private sources about any of the information noted earlier in this
paragraph in connection with HCA or one of its affiliates’ consideration of me for employment, promotion or position re-assignment or contract now, or at
any time during my tenure with HCA or one of its affiliates, and give my full consent for this information to be obtained.
II. IF APPLICABLE, medical and worker’s compensation information will only be requested in compliance with the Federal Americans with Disabilities
Act (ADA) and/or any other applicable state laws.
III. According to the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), I am entitled to know if the considerations for which I am applying
are denied because of information obtained from a consumer reporting agency. If so, I will be notified and be given the name of the agency providing
that report.
IV. I acknowledge that a telephonic facsimile (FAX) or photographic copy of this release shall be as valid as the original. This release is valid for most
federal, state and county agencies.
V. I understand that if I am a resident of Minnesota/Oklahoma (only) I may obtain a copy of the report ordered, and now indicate my desire to do so
by checking this box .
VI. I hereby authorize, without reservation, any financial institution, law enforcement agency, information service bureau, school, employer or insurance
company contacted by GIS to furnish the information described in Section I.
VII. Upon proper identification, you have the right to make a request to GIS, within a reasonable period of time, as to the nature and substance of all
information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that GIS has
previously furnished. Communications with GIS should be directed to PO Box 353, Chapin SC 29036 or (866) 265-4917.
CANDIDATE COMPLETE THE FOLLOWING:
___________
__
Signature
___________
Please print full name
Today’s Date
__
The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records.
It is confidential and will not be used for any other purposes.
Month, Day and Year of Birth
Home Address
Social Security Number
City
Driver’s License Number and State
State
Zip
Name as it appears on License
________________________________________________________
Please provide all alternate name(s) used (i.e. maiden name or previous married names)
Applicant Phone Number
Have you ever been convicted of a crime? __ No __ Yes
**Convictions are not an automatic disqualification.**
If yes, please provide city, county, state, date of conviction and details of conviction.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Previous Addresses for the Last 7 Years (use additional page if needed)
Street Address
City
State
Zip
Street Address
City
State
Zip