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Scotland County

Scotland County Health Department Volunteer Application

Thank you for choosing us to fulfill your volunteer services in Scotland County!Thank you for choosing Scotland County Health Department to perform your volunteer services. The Department will consider your application as seriously as you offered it, and will contact you if a suitable student/intern opportunity should become available. Please complete the below information.

Full Name


Employment Status

Previous Work or Volunteer Experience:




Emergency Contact Name

Are you 18 years of age or older? If not, you must have a parent or guardian's permission to participate in the volunteer program.

Are you bilingual?

Have you ever work for Scotland County?

Do you have a relative(s) currently working for Scotland County?

List names and numbers of two (2) personal references

List hours of availability for volunteer work: * Agency business hours are Monday - Friday 8:00 am to 5:00 pm

If you require special accommodations per the Americans with Disabilities Act, please indicate here.

Criminal History

Have you ever been convicted of a misdemeanor or felony?

Consent to Perform Background Check

In connection with my application and desire to engage in volunteer activities, I have been advised and I hereby consent and authorize Scotland County Health Department and its agent at any time during or subsequent to the application process, to conduct a background check that may include a criminal record check and such additional verifications and reference checks as deemed necessary. I do hereby consent to Scotland County’s use of any information provided during the application process needed to perform the volunteer services related to the background check. I agree to release, indemnify and hold harmless Scotland County Health Department and any agency used by Scotland County with regard to any information provided by the agency. I have been informed that I will have a reasonable opportunity to clear up any mistaken information provided by the agency within a reasonable time frame established within the sole discretion of Scotland County.

Certification of Information Provided

I hereby certify and attest that all information provided is true, correct and complete. I understand that any falsification of information will disqualify me for any volunteer assignments with Scotland County Health Department.

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