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Medical Volunteer Application | Volunteer Health Organizations

Medical Volunteer Application

The following form is for MEDICAL VOLUNTEERS ONLY in San Diego.

To volunteer as a non-medical support for Surgery Weekends, Dental Clinics, Internships, or Fundraising Events, click here.

This is a PRELIMINARY APPLICATION. Once you submit, someone from Fresh Start will contact you.

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    Applicant Information

    Name *

    Applicant's Address *

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    Educational Background

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    Employment Background

    complete with current/most recent employer for the last 3 years

    Employer #1

    Employer #2

    Employer #3

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    Skills & Interest

    Please mark your area(s) of qualification(s). Check all that apply:

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    Health Background

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    Electronic Signature

    By checking this box, I certify that all information stated in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration as a volunteer and may result in my immediate dismissal if discovered at a later date. I authorize and release personal references, employers (past and present), and if necessary, other applicable entities to answer questions in regards to my volunteer work,employment, ability, character, medical, and emotional background and, if applicable, driving history. *

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