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General Volunteer Application
St. Luke's Free Medical Clinic
Address: 162 N. Dean Street Spartanburg, SC 29302
Contact: Marc Rivera: (864)542-2273 Ext. 9856
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Full Name:
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Date of Birth:
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Email:
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Driver's License:
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Social Security Number:
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Address:
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I confirm that I am 18 years of age or older.
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During my time at St. Luke's Free Medical Clinic, I consent to having a SLED background check being conducted. I acknowledge and accept that if a SLED background check is conducted, there is an $8.00 fee for the background check to be paid by me when I am contacted.
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Do you have any medical experience? If so, please explain.
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