Please complete this application form if you are interested in becoming a Miami Cancer Institute Volunteer. Once you complete the form, check off I Agree, and click the Continue button.

Applicant Personal Information

First name:

Last name:

Middle name:

Title:

Address 1:

Address 2:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Other phone:

Email address:

Date of birth:

Age:

Gender:

School:

Skills:

Years in Miami-Dade County?

Emergency Contacts

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Other phone:

OK to call here

Email address:

Relationship:

List Community Affiliations & Other Volunteer Work

Please list all your community affiliations and other volunteer work you were involve in the past.

Availability (Select from 7AM to 6PM - Mon to Fri)

THIS IS MANDATORY. If you leave this information blank we automatically not consider your application...

Please indicate the days and times you are usually available to volunteer. Please keep in mind the Miami Cancer Institute’s hours of operation are from 7:00AM to 8:00PM from Monday to Friday.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

I'd like to serve up to:

hours:

References

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Other phone:

OK to call here

Email address:

Relationship:

Worked at MCI

Have you ever worked for Miami Cancer Institute or any other entity of Baptist Health?. If yes, when and where?

Family Affiliation at MCI

Does anyone in your family currently work at Miami Cancer Institute?. If yes, who?

Volunteered at BHSF

Have you ever volunteered for any BH Organizations?. If yes, when and where?

Any Convictions

Have you ever been convicted or found guilty (including nolo contendere) for a felony offense?

(Conviction of a crime will not necessarily deny volunteering. A criminal background check is part of the volunteer application process.)

If “YES,” please explain all convictions.

* Any Conviction?:

Yes

Volunteer Conditions

I understand that I must be 18 years and older.
I understand that more than one year of commitment is required.
I understand that I must read, speak, and write basic English language.
I agree to a background check.
I understand that a volunteer at Miami Cancer Institute is minimally required to work four (4) hours per week, and a maximum of sixteen (16) hours per week. Exceptions will be based on job assignments and determined by the Director or Manager of Volunteer Services.
I understand that I must complete a tuberculosis evaluation annually, which may include a skin test.
I understand that I must complete a Flu shot yearly during Flu season (10/01 to 03/31).
I understand that I may be asked to volunteer days and/or hours other than those specified at the time of placement.
I agree to abide by all the rules, and policies of the Volunteer Services Department/Baptist Health South Florida. I will attend orientation, complete health office requirements, and complete all necessary training. I will observe the Volunteer dress code, and the code of ethics, and uphold the Service Excellence Standards. I will keep all patient information confidential as required by HIPAA and Baptist Health policies.
I certify that the information on this application is true and complete to the best of my knowledge. I understand that any misrepresentation or omission of facts on this application will be sufficient cause for disqualification of this application.
I give permission to Miami Cancer Institute to verify any information provided in this application and I authorize my past references or any other persons to answer all questions concerning my ability, character, reputation, and previous employment or volunteer record. I release all such persons from any liability or damages resulting from having furnished such information.

I Agree