Please complete this application entirely if you are interested in becoming a member of the Volunteer Services Program for either Banner Gateway Medical Center, Banner MD Anderson Cancer Center, or myCancerConnection One-on-one Support Program. Once you complete the application, click the continue button at the bottom.


Facility Preference

Please select which facility you are most interested in becoming a volunteer at.


Demographic Information


Physical/Medical Background

Do you have any physical condition or medical diagnosis, which may limit your ability to perform the functions of a volunteer?


Emergency Contact

Family or Friend we can call in case of an emergency.


Work Status/Employment History

If currently employed, provide employer's name and manager's telephone number.


Volunteer Experience/Skills

Select all that apply.


Interests

Why do you wish to become a volunteer? Do you have any hobbies/interests?


Education


Personal Reference

Personal Reference should be someone that is not related to you. If you are between the ages of 16-18 years old, please bring two letters of recommendation to the interview, one from a teacher or faculty member.


Volunteer Availability

To better assist us in determining assignments that are available, please check which day/s of the week and timeframes you are available.


Background Check

Have you ever been convicted of a felony or a felony that was reduced to a misdemeanor for sentencing purposes including DWI? If yes, state the offense, location, date and disposition.


Volunteer Commitment To Confidentiality/Services

Believing that Banner Health has a real need for my services as a volunteer, I agree to:
1) Comply with the confidentiality standards regarding all patient information;
2) Uphold the Mission, Values, and Purpose of Banner Health;
3) Endeavor to make my volunteer service the highest quality;
4) Make every effort to fulfill a 4-hour per week shift and six month commitment of service;
5) I understand that Banner Health has a No Flu for You procedure, I agree to follow the requirements;
6) I understand that I am required to attend annual training and in-services, pertaining to my volunteer assignment.
7) I understand that if I am between the ages of 16-18 years old, a completed parent consent form is to be brought to the interview (once scheduled) to become a volunteer, as well as two letters of recommendation, one from a teacher or faculty member.
I understand that my services are donated to Banner Health without contemplation of compensation, or future employment and given for humanitarian or charitable reasons. I verify the preceding information on this application is true. I understand that there are many types of volunteer opportunities with Banner Health facilities, and that I will be required to complete an orientation, employee/volunteer health screening, and additional training that service assignments will require.


Acknowledgement

In submitting this application I agree to the terms outlined in the commitment of services and that all information is accurate.