Volunteer Application Form

Personal Information

Legal Name*

First NameMiddle InitialLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Email*

example@example.com

Are you fully vaccinated with the COVID-19 vaccine? Please note that volunteering at Angela Hospice requires COVID-19 vaccination.

YesNo

I am available to attend class during the:*

DayEveningEither

I became aware of the Angela Hospice volunteer program through:*

Personal hospice experienceFriend/family memberNewspaper ad or articleOther

Employment Status*

EmployedStudentRetiredUnemployed

Present or former occupation*

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Have you experienced a personal loss within the past year?*

YesNo

If yes, please list dates of death and relationships.*

Federal Information

Are You Over the Age of 18?*

YesNoNo, but I have working papers

Are You a U.S. Citizen?*

YesNo

Do You Have the Legal Right to Work and Remain in the United States?*

YesNo

Have You Ever Been Convicted of a Felony?*

NoYes

Thank you for your interest. Unfortunately, due to your previous conviction, you will not be able to qualify for our volunteer program. Thank you for your understanding.

If Yes, State Nature of Offence (When, Where, and Disposition)*

Education

Please check last year completed:

High School

1234

College/University

1234

Post Graduate

1234

Veteran Status

Are you a veteran?*

YesNo

If yes, what branch did you serve?

Personal Information

Federal Information

Education

Veteran Status

Volunteer Interest

Volunteer History

Personal References

Authorization and Understanding