Basin Hospice Volunteer Application

Hospice Volunteer Application

Join Our Compassionate Team: Apply to Volunteer Today.
Volunteer Information
Name
Address
Phone
Email
example@example.com
How did you hear about us?
Availability

When are you available to volunteer? (Check all that apply)
Days

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Times

MorningAfternoonEvening
How many hours per week can you volunteer?

Less than 55–1010–1515+
Date available to start

MonthDayYear
Date
Skills, Interests, and Hobbies
Please list any hobbies special interests or skills that might be helpful for volunteering
Do you speak any languages fluently other than English?

YesNo
If yes, please specify
Emergency Contact
Name
Relationship
Phone
Volunteer Experience & Special Interests
Have you worked in hospice before?

YesNo
What type of volunteer work are you interested in?

Clerical/office supportDirect contact with hospice patientsBereavementOther
Why do you want to volunteer for Basin Hospice?
Background Check
Have you had a criminal background check within the past year?

YesNo
Have you ever plead "guilty" or "no contest to, or been convicted of a crime?

YesNo
If yes, please provide details
References

Please provide two references from school, church, employment, or past volunteering. No relatives or close friends, please.
Reference 1
Reference 2
Education & Employment History
Highest Education Level Completed
Present Occupation
Employer
Additional Employment History 1
Additional Employment History 2
Volunteer History
Volunteer History 1
Volunteer History 2
Physical Requirements

The volunteer position may require the following:
- Walking, sitting, talking, hearing, and using hands/arms to operate controls.
- Occasionally climbing or balancing
- Lifting and/or moving up to 70 pounds.
- Specific vision abilities, such as close vision and ability to adjust focus.
By signing below, I acknowledge I can meet these requirements or will notify Basin Home Health and Hospice if I have concerns.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Hospice Volunteer Application

Volunteer Information

Availability

Skills, Interests, and Hobbies

Emergency Contact

Volunteer Experience & Special Interests

Background Check

References

Education & Employment History

Volunteer History

Physical Requirements