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Volunteer Application

Date of Application:

Name:

DOB:

Email:

Home Phone:

Cell Phone:

May we contact you at work? YesNo

Hours that you work:

Total Number of hours per week you could be available for hospice volunteering?

How many days per week?

Employment: Pleas list your employer(s) for the past five years

Languages spoken other than English and Fluency Level:

Education/Special Training skills/work experience: Please list any items which may be helpful in your volunteer role , i.e. Certification, Hobbies, Administrative skills, ETC

Personal Information:
Do you have volunteer Experience? Please Specify:

How did you learn about catholic hospice?

What inspires you to join the Catholic Hospice team?

Are you comfortable working with someone of a different religious faith than you? YesNo

Are you able to work with someone who practices a different lifestyle than you? YesNo

Are you willing to provide transportation for Patient/Family if needed? YesNo

Are there any special circumstances relating to your health that we should consider when assigning you to a patient? YesNo
If yes, Please Explain

Have you Experienced the loss of a loved one -Friend or Family? YesNo
If yes, when did this occur?

How did this person's death affect you?

Volunteer Oportunities
Please indicate your volunteer area of interest(s)
Patient CareBereavement VisitationBereavement Telephone ContactBereavement MailingsClericalFund RaisingPublic Relations

Professional Consultation (Specify area of expertise)

Other Please Specify

References
Please list three personal references (no relatives) whom you have known for at least one year.
Name/Address/Telephone#

The information provided in the application process will assist us in determining appropriate volunteer assignments. The Catholic Hospice team is committed to making your experience rewarding and beneficial to the community which we serve. Thank you for your interest in volunteer opportunities with Catholic Hospice.