VOLUNTEER APPLICATION

VOLUNTEER APPLICATION


Thank you for interest in becoming CCHE57357 volunteer; YOU must be 18 years of age or older. Volunteering begins with a commitment. At CCHE57357 we encourage all volunteers to serve at least three hours a week for at least THREE months or complete 36hours of volunteer service

Please review the form to ensure that all required fields are
Completed

Contact Information

Title :
Mrs.Mr.Dr.

Date of Birth

- -







Education

Are you currently enrolled in school or will you be enrolled in school during the next 12 months?

YesNo

Level



If yes, where?


Degree or Major
Undergraduate (Please indicate your classification below)

If Undergrad, please select classification

Emergency Contact

In case of emergency, please notify:





References:

Please provide the names of two individuals who would be willing to give a character reference. A preferred reference is someone who has known you greater than three years and is not a relative.

Are you currently employed?

Yesno
















Patient Relation

Our policy states that if you are a family member of a patient, the patient must have reached annual visitation status. If family member is deceased, you must wait one year before volunteering.

Have you ever been a cancer patient or are you a family member of a patient or previous patient?

NoYes ,Describe

If yes to above, please indicate years since treatment

1-56-1011-1516 or more

Are you involved in a Family Centered Care initiative?

NoYes ,Describe

Availability

We ask that you make a commitment of at least three hours a week for at least three months or complete a minimum total of 36 hours. Opportunities are available from 9:30 am to 4:00 pm five days a week from Sunday to Thursday.

Volunteer Experience

Please list your volunteer experience.

Do you have volunteer experience?

YesNo

Volunteer Placement

After looking at the Volunteer Placement Summary Page, please signify your preferred assignment by indicating which of the following interest you most.

Skills

Please let us know if you have any special skills you would like to share

Other Skills (describe)

If foreign language was selected, which language?

Describe your level of fluency in this Language?


Questions

Please answer the following questions so that we can determine the volunteer placement that best matches your interest and experience.

1. How did you become interested in volunteering at 57357?

2. What would you like to gain from your volunteer experience?

3. What experience have you had in working or caring for children? What about being around sick children? What experience do you have in a hospital setting?

4. With what age group do you feel most comfortable? Least comfortable?

5. What do you consider your strength as a volunteer?

6. What would present the toughest challenge to you in your role as a volunteer at 57357?

7. Do you enjoy taking a leadership role, or do you prefer assisting the person in charge?

8. Do you prefer working with children in a group setting or one-on-one?

9. How would you handle the stress and emotions that come with working with children who have life threatening illnesses?

10. Looking at hospitalization from a child's point of view, what do you feel are his/her most important concerns?

11. Are you aware of any reason that would prevent you from volunteering on a consistent, weekly basis or might limit your ability to volunteer at 57357 ?


Confidentiality

Please read and initial at the bottom indicating that you have read and understand the following.
I understand and agree that in the performance of my duties as a volunteer of Children's Cancer Hospital-57357 Egypt , I must hold patient information in confidence. Hospital volunteers have an ethical responsibility to protect patient privacy. Information regarding[ patients, Hospital and foundation] must not be released, disclosed or discussed either inside or outside the hospital.
Without[ patient –hospital –foundation ]authorization. I understand all may result in punitive action including possible termination.
As a volunteer I will consider all confidential information that I hear about patients, families or hospital personnel as private. I will not discuss a child's medical condition unless the child or family initiates a discussion.

Initials


Background Check

I certify that the information given by me in this application is true and complete. I understand that any false information, misrepresentation, or concealment of fact is sufficient grounds for my immediate discharge by 57357.
I understand and agree that my birthday and ID number, along with my other personal information, are voluntarily being submitted by me electronically via the World Wide Web to 57357 on this Volunteer Service Application. I further understand and agree that information related to my birthday and ID number may be used for the purpose of a criminal record check if I become a final candidate for volunteering.

Termination

I understand and agree that my volunteer services can be terminated with or without cause and without notice at any time at the option of either 57357 or myself. I also understand that volunteers must be at least 18 years of age and that volunteers must wear a volunteer badge while on duty.

Please Upload Your Photo