Please complete this application form if you are interested in becoming a Southeastern Regional Medical Center, Inc. volunteer. You must be 18 years or older. Once you complete the form, click the submit button at the bottom.

Name and address



Please indicate the days you are available to volunteer.

Most recent/last employer

List Volunteer Experience


In case of Emergency, Notify

Non-Smoking Policy

SOUTHEASTERN REGIONAL MEDICAL CENTER, LLC NOTICE OF OUR ANTI-SMOKING AND TOBACCO PRODUCTS POLICY In furtherance of our mission, Southeastern Regional Medical Center, LLC (Southeastern) is a smoke and tobacco-free facility. Smoking and use of tobacco products (including cigarettes, pipes, cigars, chewing tobacco, snuff, clove cigarettes and similar products -- collectively, Tobacco Products) are prohibited at all Southeastern facilities. By signing this application, you are certifying that you are not a smoker or other user of Tobacco Products and that you agree to comply with Southeastern’s policies relating to smoking and tobacco use while volunteering with us.

Volunteer Agreement

I certify that the information I have provided on this application is true and complete to the best of my knowledge. I understand that misrepresentation, falsification, or omission of information may disqualify me from further consideration for volunteering, or may result in my termination as a volunteer at the Cancer Treatment Centers of America®. If accepted as a volunteer, I understand that I must abide by all of the policies, rules and regulations of the hospital. I authorize Cancer Treatment Centers of America® Volunteer Services Department to investigate all statements contained in this application and to make inquiries of my personal references and medical history, as well as run a background check, as well as other related matters as may be necessary for determining my eligibility as a volunteer. I hereby release employer’s schools or individuals from all liability in responding to inquiries relating to my volunteer application.