Volunteer Application

Please specify any other services, not listed above, that you are interested it.

Please list any employment history, education, special training, hobbies, interests or memberships in any club, organization, society, professional organizations or other volunteer work that you believe is related to hospice volunteer activities.

Please list any professional licenses, registrations and/or certificates held. Be sure to include the type of license, who it is issued by and the date issued for each.

Other than English, do you communicate in any other languages? If so, what language(s)?

Please note any medical conditions or physical restrictions which need to be taken in to consideration when arranging volunteer assignments for you.

Please indicate your hours of availability for each day of the week. Indicate preferred times with an asterisk (*).

As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professional in the field in which I work. I, like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me. I understand that any information that is disclosed to me while assisting the Hospice is confidential. I interpret volunteer to mean that I have agreed to work without compensation in money. Having accepted as a volunteer worker, I expect to do my work according to the standards set forth in the volunteer policies and procedures. Information provided on this application is confidential and will only be considered in relation to positions to which this application pertains.

I hereby certify that the statements on this application are true and correct to the best of my knowledge. I understand that by submitting I authorize inquires to be made concerning my employment, character and public records for the purpose of determining my suitability as a volunteer. I affirm that I have read the volunteer code of ethics and agree to abide by its regulations. I agree to respect the confidentiality any client information I acquire in the course of my volunteer activities with the Hospice. I authorize Physician’s Choice Hospice to conduct background check and a drug screen on me according to the Pre-employment background checks/ drug screen policies. I understand that my volunteer work may not begin until satisfactory background and drug screening information has been received. I also understand that Physician’s Choice Hospice will assume all costs of this background and drug screening research. I understand that Physician’s Choice Hospice reserves the right to accept or reject my application in its sole discretion and that the above statements made in this application are true to the best of my knowledge.