Cancer and Blood Disorder Center (CBDC)

Clinical Partner Employee Application

> If you have any questions about this application, please contact cbdcbmtadmin@seattlechildrens.org.

 

> The purpose of this application is to initiate the process for non-employees/ nonW-2 (affiliate role) to be onboarded as Clinical Partner Employees at Seattle Children's.


> This application is ONLY for FHCC clinic and non-clinical and UW staff related to Cancer and Blood Disorder Center (CBDC) work


>Other (non-FHCC/UW) CBDC partner institutions who work at partner organizations can use this form


> If your work does NOT support CBDC related work, please email Seattle Children's HR for further instructions at non-employeeadmin@seattlechildrens.org


> FHCC research related requests are process by partneraccess@seattlechildrens.org

 
 
 
 
 
 

Preferred name if different from "Applicant First Name"

 
 
 

Please include initials in the following order: first initial, middle initial (if applicable), then last initial. For example if you name is Summer Smith please include the initials "SS" or if Summer Jr. Smith then "SJS".

 
 

Please only provide your work email

 
Phone
 
 

Home Institution Supervisor/Manager Information

 

Home Institution Supervisor/Manager Information

 

Home Institution Supervisor/Manager Information

 
 
 
 
 
 
 

Role Information

The main purpose of this section is for non-employees to describe the work that they will be doing at Seattle Children's. The information listed will also help us to support your access request.

 
 
 
 
 
 

Attestation

Please review the information provided. The applicant attests that the information is accurate and complete and is being requested because their role requires Seattle Children's access to fulfill a job duty in collaboration with CBDC and their home institution.