Applications for Volunteers

Health Center Volunteer Application and Process (All Volunteers)

New Life Community Health Center
Documents Required for Personnel Files
Required Documents with your Signature:
  • Current Resume, signed and dated
  • I-9 form (see instructions at )
  • Confidentiality Agreement (document attached)
  • Completion of the Application for Professional Privileges (for MD, DO, DDS, NP and PA personnel only)
Photocopy of Existing Documents you should have as a Medical Provider:
  • Diplomas from any professional schooling
  • Professional license/registration
  • Any certificates you might have (for example Basic Life Support/Advanced Cardiovascular Life Support)
  • Malpractice insurance coverage, if you carry it
Copies of Required Trainings and proof of Malpractice History:
Personal Medical Data:
  • Physical exam within the last year - this can be a letter from your MD with the date of exam and verification that, "the health status of each employee is examined prior to the beginning of employment, which is sufficient in scope to ensure that the employee is free from a health impairment which is of potential risk to patients or which may interfere with the performance of his/her duties"
  • PPD reading within the last year (read in mm's not just as positive or negative)
  • Rubella, Rubeola, and Hep B titers or records of the vaccinations
  • Record of Influenza vaccine (new NYS regulation for all health care providers, if you do not want to or cannot have the vaccine, you will need to sign a waiver and wear a mask for all patient contact for the entire flu season)
  • Record of COVID-19 vaccine and any booster shots.
Items you will need to Request from Others:
  • Letter of completion of residency (for MD, DO and DDS personnel only)
  • 2 letters of reference - one from your current place of employment and one from a personal source who can speak to your character and faith