Please note: due to the high volume of applications received, not all applicants will be admitted to the program.

Please complete this application form if you are interested in becoming an Adult Volunteer with Levine Cancer Institute. Once you complete the form, click the submit button at the bottom.
All volunteers will be required to complete a criminal background check, health screening, and volunteer orientation. This process can take 4-6 weeks.

Name and address


Education


Other Languages


Emergency Contact Information


Previous Volunteer Experience

Please list your previous volunteer experience, including the organization's name and length of time with the organization.


References

All applicants must submit two references who are not relatives. Please provide complete information for personal references that have known you for a minimum of two years. Reference emails will be sent to those listed below.


Employment History

Please list your most current employer and phone number. Be sure to also list your position, and dates of employment.


Service Preferences

Please select your top two service preferences. Visit the following link to see available Volunteer positions: https://www.volgistics.com/ex/portal.dll/od?from=141575.

Please note: this will bring you to a separate page that will display open positions for several facilities. Scroll down to view available positions for Levine Cancer Institute.


Why do you wish to volunteer?


Availability

Volunteers are required to commit to a regular, weekly shift. Shifts are typically 2-4 hours in length.


Patient Status


Background Check Disclosure

Atrium Health obtains arrest and conviction records for all potential volunteers. An arrest or conviction will not automatically eliminate you from consideration, however failure to list all pending charges and/or convictions may lead to your disqualification.

Have you ever been convicted of any criminal violation of law, or are you now subject to a pending investigation of charges for violation of criminal law? If yes, please explain below:


Volunteer Agreement

As a volunteer:

I will consider as confidential all information which I may hear or see, directly or indirectly, concerning a patient, patient family member, doctor, or other health care professional and I will not seek information from any of the above in regard to a patient.

I hereby certify that the answers on this application and any resulting from interviews are true and correct and that any misrepresentations or omissions of facts, misleading, or false information on my part will be grounds for dismissal as a volunteer. Acceptance as a volunteer is contingent upon satisfactory references, verification of information submitted on the applications and satisfactory completion of mandatory requirements. I authorize that all employers, schools, or references thus contacted be released from all liability in answering questions related to my application.

I understand that I am required to commit to serve a regular, weekly schedule.

My services are donated to Atrium Health without contemplation of compensation or future employment and given with humanitarian or charitable reasons.

I authorize Atrium Health to administer emergency medical treatment to me while volunteering. I understand that Atrium Health is not responsible for volunteers before or after their assigned shifts.

We will make every effort to match your abilities to our volunteer needs at Levine Cancer Institute. Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sex. The first 90 days of the volunteer experience are mutually probationary.