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Rehoboth McKinley Christian Health Care Services

Auxiliary Membership Application

Once your application is processed, you will be contacted. If accepted for membership, you will need to complete orientations and training.

You will need to pay the dues and purchase a uniform during the auxiliary orientation.
* Name
Last, First, Initial
* DOB
Date of Birth Month/Day only
* Gender Male     Female    
* Mailing Address
* Phone
Home
* Cell
* Spouse/Partner
If applicable
* Email Address
* Membership Category
* Active members are able to donate time for voluntary service each year, have voting privilege, and are eligible to hold office. * Patron members are those who support the Auxiliary through their financial donation. They receive information, but are not expected to participate with the fund raising activities. They are not eligible to vote or hold office.
Active - $10     Patron- $25    
* Emergency Contact
Name: Relationship: Phone: Alternative Phone:
* Volunteer/Work Experience References
If you have volunteered and/or worked for other organizations, attach extra pages or a resume.
* Organization
* Dates of Service
* Contact Person
Name and Phone Number.
* Your Duties
List jobs and duties.
* How did you hear about the RMCHCS Auxiliary
  Have you ever been employed by RMCHCS Yes     No    
  If yes
Position, Dates, Department, Supervisor and #
* Conviction of a Crime
Have you ever been convicted of a felony
Yes     No    
  If yes
Please explain. * Conviction will not automatically disqualify you from consideration. The type and seriousness of the crime, along with your history, and the position in which you are interested, will be considered.
* Education
High School Attended
* Graduated Yes     No    
  College/University Attended
* Major/Degree
  Special Training
  Special Training
  Service Area
Check all that apply.
Book Cart
Gift Shop
Information Desk
CommitteeWork
  Availability
Check all that apply
Monday
Tuesday
Wednesday
Thursday
Friday
Occasional Substitute
* Times Mornings
Afternoons
Additional References
List two people who are not friends or relatives. Please include people with whom you have worked. For additional work experience, use the back or attach a resume. Your application indicates we have permission both to check and to later provide references.
* Reference
Name: Relationship: Organization: Daytime Phone: Evening Phone:
* Reference
Name: Relationship: Organization: Daytime Phone: Evening Phone: