Volunteer Application

Volunteers are vital to our mission of providing compassionate care for all, regardless of ability to pay.

They provide a special kind of caring and practical help for our patients and their families or work alongside our staff behind the scenes.

Whether it’s offering a listening ear to patients and families, providing respite care for exhausted caregivers, helping us prepare a large mailing, or sharing personal expertise, the hours our volunteers give can be the most rewarding experience of their lives.

Our volunteers come from all walks of life. Some work during the day, some are retired, and others volunteer while attending school. Whatever your life allows, we work with you to find an opportunity that fits.

While training is required, we make it as easy as possible to get started.

Volunteer Application

Downloadable Volunteer Form

Volunteer Training

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Volunteer Application Form

Thank you for your interest in volunteering. This information will provide us with an understanding of your interests and abilities. Some questions may seem personal; however, the information is helpful in determining the best role for you.

General Information

Name

First

Last

Home Phone

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Education and Employment:

Educational Experience:

Employment Experience:

Are you currently enrolled in school?

Are you currently employed?

Educational Level:

Employer:

Position/Hours:

Additional training, certifications, license...

Briefly describe the type of work you do:

Personal Information:

Have you done other volunteer work? If yes, briefly describe:

Why do you wish to be a volunteer?

Programs and Placements:

References:

Give the names of two persons not related to you, whom you have known at least one year. Sharing their information means you authorize Hospice to contact the persons listed below to obtain personal reference checks.

Reference 1:

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Phone

Relationship

Years Acquainted

Reference 2:

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Phone

Relationship

Years Acquainted

Emergency Contact

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Phone

Relationship

Years Acquainted (copy)

Section Divider

Please read the following statement carefully before signing to indicate your understanding:

I certify that the facts contained in this application are true and complete to the best of my knowledge. I authorize investigation of all statements contained herein and the references listed above, and release all parties from liability for any damage that may result from furnishing same to you.

I understand as a condition of my volunteer service, I will be required to undergo screening and other pre-service requirements.

Signature

Clear Signature

Date / Time

Date

Time

Isn’t it expensive?

NO. The cost of care is covered by Medicare, Medicaid, and private insurance. Our palliative and grief care programs are donor supported and you are not invoiced for care.

We provide care for all, regardless of insurance status or ability to pay.

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