Volunteer Application

Your Name

Nickname (if applicable)

Phone (best number to reach you)

Email

Birthday (just month and day)

Home Address

City and Zip

Employer and Occupation

I am:

Best way to contact (weekday/daytime)

Areas of Volunteer Interest (select all that apply)
Patient CompanionOfficeBereavementSpecial ProjectsLicensed/Professional

SCHEDULING

Best Days to Volunteer (select all that apply)
SundayMondayTuesdayWednesdayThursdayFridaySaturday

Best Times to Volunteer (select all that apply)
MorningAfternoonEvening

Please provide two personal references. Include name, phone, email and relationship. (Non-family members only please)

Reference #1

Reference #2

Why do you want to be a hospice volunteer?

What personal characteristics will enable you to work with people who are facing a terminal illness?

Please describe any work or other experiences which you feel have prepared you to be a Patient Care Volunteer

List any special skills, hobbies, talents that could be incorporated with your Patient Care Volunteering (Bilingual Volunteers for Spanish-speakers, musicians or singers, pet-companion volunteers, registered massage therapists, cosmetologists, etc,):

Do you know any language other than English?
YesNo

If yes, please specify (Speak, Read, Write)

DEATH & DYING

How long ago was the last death that impacted you, and what was the relationship?

What are your experiences with terminal illness and death?

What are your thoughts and feelings about death?

How did you hear about Tranquil Care Hospice?

Other:

Please list any dietary restrictions (vegetarian, lactose intolerant, food allergies etc.)

Declaration

By checking this box, I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that, by submitting this application I authorize inquiries to be made concerning my employment, character and public records for the purpose of determining my suitability as a volunteer.

Signature (complete your full name)