Volunteer Application Form First Name Last Name Email Phone Street Address Line 1 Street Address Line 2 City State Zipcode Emergency Contact First Name Last Name Relationship Phone Skills, Hobbies, or Area of Interests you would like to offer as a hospice volunteer Do you speak a language(s) other than English? Please specify. What type of employment experience do you have? Which days are you generally available to volunteer? SundayMondayTuesdayWednesdayThursdayFridaySaturday Which times of day are you generally available to volunteer? MorningsAfternoonsEvenings What drives you to volunteer for Holistic and Palliative Care? What has been your experience with hospice (as a family member, friend or volunteer)? Do you have any previous experience as a volunteer for hospice, or any other organization? Please specify. Please list three references (unrelated to you) that we may contact. Include name and email address. Has someone close to you passed away within the last year? —Please choose an option—YesNo What has been your experience with life threatening illnesses and/or death? Have you ever been convicted of a felony? —Please choose an option—YesNo
