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Volunteer Application

Care One Hospice Volunteer Application

Volunteers are a valuable asset to Care One Hospice. The presence and the assistance they provide enhances the quality of care we offer our patients and families. They bring a variety of life experiences, strengths and personalities that really help support patients and their families. With their unique talents, our hospice volunteers serve as patient and family advocates and help bring dignity and compassion to the end of life.

If you would like to offer your time and join our family of volunteers please fill out the form below.

Volunteer Information

* Your Name

* Phone Number

* Contact Email

* Street

* City

* State

* Zip Code

Date of Birth

Emergency Contact Person

Emergency Contact Person

Relationship

Phone Number

Experience

Occupation (if applicable)

Employer

Business Phone

Employed

Business Skills:

Personal Information

Education Level:

Education Major:

Languages Spoken

Personal Interests

Volunteer Area of Preference

Days/Time of Day Not Available

Prior Experience

Volunteering

Participation in Community Organizations

Have you had experience with terminally ill?
YesNo

Have you experienced the death of a family member or friend within the last year?
YesNo

Transportation

Do you drive?
YesNo

Do you have a car at your disposal?
YesNo

Do you have car insurance?
YesNo

Personal References

Reference One

Reference Name

Phone Number

Street

City

State

Zip Code

Reference Two

Reference Name

Phone Number

Street

City

State

Zip Code

 

Fields denoted with asterisk (*) are required.