Returning Volunteer
New User Details
User ID
User ID (verify)
Password
Password (verify)
A
pplicant Information
*
First name
*
Family/last name
*
Phone (Mobile)
Phone (Home)
*
E-mail Address
Address
*
Line 1
Line 2
*
City
*
State
*
Zip/postal
Volunteer Assignment
*
What was your former assignment?
Please select one( assignments are based on availability and hospital need):
I would like to return to my former assignment
I would like to try a new assignment
N/A
*
Date you are available to return
Uniform/ ID Badge
Do you have your Penn Medicine Princeton Health Volunteer Uniform(Blue jacket or Polo with Penn Shield Logo) ?
Yes
No
Do you have your Penn Medicine ID Badge?
Yes
No
Have you committed a crime since you last served?
Yes
No
If Yes, please provide details concerning your conviction:
Recommitment/ Understanding
*
I recommit to maintaining confidentiality on all information(patient or other) that I come in contact with, regardless of the source. I understand that I must report any violations of the confidentiality and non-disclosure agreement that I signed when I originally began service.
*
I acknowledge that I am familiar with the policies and procedures that were in place when I last volunteered. I agree to abide by all the PMPH rules, regulations, policies and procedures and understand that they are subject to change at any time.
*
I understand that it is my responsibility to seek clarification, from my supervisor or the Volunteer Services staff, on any matters which I do not fully understand during the course of my service.
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Signature
