Please complete the following application to be considered for a volunteer position.

We are currently looking for nurses, APNPs, PAs and doctors to join our team, including Spanish-speaking volunteers.

Your Name *
Your Name
Home/Primary Address *
Home/Primary Address
Mailing Address
Mailing Address
Optional: Provide if you have a different address for mail.
Primary or Mobile Phone
Primary or Mobile Phone
Secondary or Home Phone
Secondary or Home Phone
YOUR BACKGROUND
AVAILABILITY
Weekly Availability
The best times for me to currently volunteer are as follows:
EXPERIENCE
EXPERIENCE (Health Care Professionals Only)
EMERGENCY CONTACT INFORMATION
Name
Name
VOLUNTEER COMMITMENT
BESTD Clinic requires a 12-month commitment and requires that volunteers volunteer at least one time each month. I will honor the time and task commitments I make and fulfill them as one of the priorities of my life. If illness or an emergency prevent me from honoring my commitment, I will either attempt to find someone to replace me or notify the Clinic with the longest possible lead-time. I will not knowingly allow client service to be less than adequate or my volunteer colleagues to have to double up due to my negligence, irresponsibility or lack of commitment.
SIGNATURE
Today's Date
Today's Date