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New Volunteer Application w/job signup
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Mission
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New User Details
User ID
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Password
Password (verify)
Thank you for re-applying! Please update your profile below. Your user ID and password will remain unchanged.
Personal Info
*
Legal First Name
MI
*
Last Name
Suffix
*
Home Address
*
City
*
State
*
Zip Code
*
Home phone
Mobile phone
Work phone
*
E-mail address
*
DOB
You must be at least sixteen years old to volunteer.
Gender
Female
Male
Not disclosed
Preferred pronouns
'Her', 'Him'
'Hers', 'His'
Emergency Contact Information
Contact name
Address
City
State
Zip Code
Home phone
Mobile phone
Work phone
E-mail address
Character/Professional Reference
Name
Title
Organization
E-mail
Relationship
Pastor/religious leader
Law enforcement
Friend
Teacher
Professional
Other
Skills and Special Requests
Skills
Administration/Office
Child Care
Computer - Data entry
Custodial
Emergency Management
Event Planning
Food Services - Delivery
Food Services - Preparation
Fundraising
Gardening
Grant writing
Language/Translator
Marketing/Communications
Medical - Doctor/Physician
Medical - Nursing
Transportation - Driver (car)
Transportation - Parking
Special requests/needs
Assignments - Indoor
Extra supervision
Meals - Vegetarian
Needs transportation
No heavy lifting
Positions
Primary Clinic (Select one or more):
A Clinic: Leukemia
B Clinic: Bone Marrow Transplant
D Clinic: Solid Tumor
E Clinic: Neurology
H Clinic: Hematology
ACT Clinic: After Completion Therapy
ID Clinic: Infectious Disease
RO Clinic: Radiation Oncology
Other (please specify below)
Preferred position
Kids Art Cart
Office Assistant - Volunteer Services
Patient Advisory - Metro
Patient Advisory NICU
Research Volunteer
Alternate position 1
Kids Art Cart
Office Assistant - Volunteer Services
Patient Advisory - Metro
Patient Advisory NICU
Research Volunteer
Alternate position 2
Kids Art Cart
Office Assistant - Volunteer Services
Patient Advisory - Metro
Patient Advisory NICU
Research Volunteer
Requests
Requested site
Ambulatory Clinics
--Clinic #1
Medical Centers
--Medical Center East
--Medical Center North
Regions
--Region A
--Region B
--Region C
Research Lab
Suburban Hospice
Other
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Tell us about yourself
PLEDGE OF CONFIDENTIALITY I understand and agree that in the performance of my duties as a volunteer, I must hold patient information in strict confidence, revealing information only to those authorized to receive it. Further, I understand and agree that any violation of policies on confidentiality may result in disciplinary action, including suspension from duties or immediate dismissal. I understand that I am required to attend a volunteer orientation session in a timely manner in order to enhance my understanding of the importance of confidentiality as well as maintaining appropriate boundaries. If necessary, I agree to have references contacted by Volunteer Services.
