Welcome to our on-line volunteer application

Thank you for your interest in volunteering. Please have all necessary information available when completing this application, there is no option to save and return. Thank you

FCCC Adult Volunteer Application Form

First name
M.I.
Gender
Family/Last name
Preferred Nickname
Title
Address
City
State
Zip/postal
Work phone
Home phone
Mobile phone
E-mail
Emergency Contact Information
Contact name
Relationship
Address
City
State
Zip/Postal
Home phone
Mobile phone
Work phone
E-mail (if applicable)
Additional Information
How long can you commit to volunteering?
Volunteer source
Primary Language
Please list any additional languages
Skills
Uniform Size
What type of assignment(s) interest(s) you?
If any, please indicate other interests
Yes, I have been accepted into a Lab or Program at FCCC
Lab Contact
Lab Name
If you know your start date, please enter it here:
I am a student
School/College:
Major or Program
Expected Graduation Date
Street Address
City
State
Zip/Postal
I am employed
Employer
Occupation
Street Address
City
State
Zip/Postal
I am retired/unemployed
Availability
Time slots marked with (*) indicate very limited positions.
Monday
Tuesday
Wednesday
Thursday
Friday
References
Please list two people (other than relatives or friends) who would be willing to serve as personal references.
Reference 1
Relationship to Reference 1
Name
Address
City
State
Zip/postal
Phone
E-mail
Reference 2
Relationship to Reference2
Name
Address
Zip/postal
City
State
E-mail
Phone
Attestation of Application Answers and Information Provided
I understand that the statements made in my volunteer application are true and correct and have been given voluntarily. I understand that falsification of any information is grounds for dismissal. I voluntarily give TUHS/FCCC the right to make an inquiry of my past experience and I agree to cooperate in such inquiries and release from all liability or responsibility all persons, companies, and corporations supplying such information. I voluntarily give TUHS/FCCC permissoion to contact my references provided above. I understand that I will not be compensated for my services as a volunteer and I am not required to volunteer my services. I understand that acceptance as a volunteer at TUHS/FCCC is contingent upon satisfactory completion of all pre-placement procedures which include but are not limited to orientation, an interview, criminal background investigation(s), completion of HIPAA Certification and completion of required health screenings. I understand that upon my successful completion of the volunteer service on-boarding processes required at TUHS/FCCC and the approval for placement by volunteer Services staff, I will become a volunteer. I agree to abide to the policies of TUHS/FCCC and if I do not, this may result in disciplinary actions. I am aware of and will honor the schedule commitment I make during my interview with Fox Chase Cancer Center Volunteer Services.
I have read the statement above and I understand and agree.
Date
Signature (Electronic)