I hereby certify that the foregoing statements are true and correct to the best of my knowledge and belief and have been given voluntarily. I understand that Allegheny Health Network requires certain information both personal and professional from me to evaluate my qualifications and consider me for volunteer services. I understand that in consideration of my application, a background investigation may be conducted. I hereby grant Allegheny Health Network permission to verify such answers and investigate all references, and conduct such further investigation as is necessary, including, but not limited to, the performance of medical examinations, drug screening, reference verification, military service verification, and criminal background checks. I understand that any false statements or incomplete information on this application may be considered sufficient cause for rejection of this application or for dismissal if such information is discovered subsequent to my volunteer work. I authorize any past and present employers, personal references, and other organizations, to answer all questions asked concerning my previous employment and/or volunteer record, ability, character, educational background, military service, or criminal history. I hereby release all employers, persons or organizations, from any liability whatsoever for providing this information. I understand that I may be asked to discontinue my volunteer services at any time for any reason. I understand that Allegheny Health Network will not be responsible for any personal injury or property loss that may occur to me while performing volunteer services.

I understand that I will not receive any monetary compensation from Allegheny Health Network, individual employees or anyone else for serving as a volunteer. I hereby agree to abide by all policies and procedures of Allegheny Health Network. I will treat information regarding patients and employees in strict confidence.

By submitting this application I agree with the Applicant’s Certification.

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