Requirements: Must be 21 or older, complete background check, TB test, volunteer orientation, flu shot (depended on season)

Adult Volunteer And Background Check – Fillable Application 4.16.2021




    Prefered Contact *

    Gender *

    Emergency Contact Information

    Do you have any physical or medical conditions which will limit your ability to perform volunteer service or will require any special accommodation? *

    History and Availability

    How did you hear about our volunteer program? *

    Employment / Experience / Education

    Work Status *
    StudentHomemakerRetiredEmployedSeeking Employment

    Level of education completed *
    HS DiplomaGEDUndergraduateMastersPhDSome College

    Volunteer Availablity

    Please place a "Y" in available work areas *











    Do you prefer *
    Patient ContactNo Patient ContactClericalOther

    Are you willing to be called with special projects? *

    Background Check

    A background check will be conducted on all adult volunteer applicants. CTC conducts criminal history checks on every volunteer. Please note that conviction of a crime is not an automatic disqualification. Failure to disclose or provision of false information will result in the disqualification and/or termination of the application.

    No volunteer at CTC will discriminate against an applicant for volunteering or a fellow volunteer because of race, creed, color, religion, sex, national origin, ancestry, age or any physical or mental disability."

    Is your volunteer service intended to satisfy court-ordered community service? *

    **Please attach a copy of your driver’s license and a copy of your food handler’s card, if applicable.** Professional Volunteers please attach applicable licensure or certifications.

    Volunteer Commitment to Confidentiality and Service

    Should I be accepted as a CTC Volunteer, I agree to:

    • Maintain the confidentiality of all information which I may obtain directly or indirectly concerning patients, physicians, volunteers or staff.

    • Not seek confidential information in regard to any patient.

    • Uphold the Mission, Vision, Values, and Code of Conduct of CTC.

    • Make every effort to fulfill my volunteer commitment.

    I certify the statements made in this application are true and correct and given voluntarily. I understand that my time and services are donated to CTC without contemplation of future employment and also understand that I will not be paid for my services as a volunteer. Prior to the onset of serving as a volunteer, I
    understand that I will be required to complete an Orientation, Occupational Health Screening, and additional training that a service assignment may require.

    I am aware that the misrepresentation and/or withholding of information may result in the rejection of this application or cause my discharge if discovered after volunteer service commences.