Volunteer Application
Thank you for your interest in volunteering with Circle of Life. Please complete this form as thoroughly as possible. Once submitted, we will be in touch to schedule an interview.
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Date of birth
*
-
Month
-
Day
Year
Date
Do you currently have any pending criminal charges, or have you ever been convicted of a crime?
*
Yes
No
If yes, please include the dates and a brief description of the offense.
Have you lived outside the state of Arkansas in the past 3 years?
Yes
No
If yes, please provide the state, address, and the dates you lived there.
Person to be notified in an emergency
*
First Name
Last Name
Relationship of emergency contact
*
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Email
example@example.com
How did you learn about volunteer opportunities at Circle of Life?
If a volunteer or staff member referred you, please provide their name.
Previous/current volunteer experience. (Please enter where you volunteered and the dates)
Education/Special Training (Please list any training or experience relevant to hospice work)
Special Interests/Hobbies
Do you speak any languages in addition to English?
*
Yes
No
Please list languages
Are you currently employed?
*
Yes
No
What type of volunteer work are you interested in?
*
Patient Support
Administration/Welcome Desk
We Honor Veterans
Music
Pet Peace of Mind
Hospets (therapy animals)
Memory Makers/Crafters (quilts, blankets, bears, scrapbooking, flower arranging)
Licensed Massage Therapy/Hairstylist
Other
Has anyone close to you died in the past 13 months?
*
Yes
No
What inspired you to volunteer with Circle of Life?
*
How many hours per week can you commit to volunteering? (enter a value between 0 and 40)
What times of day are you available to volunteer? Please check all that apply.
Mornings
Afternoons
Evenings
Weekdays
Weekends
Other
Are you allergic to anything?
Yes
No
Please list
Do you have any medical conditions we should be aware of?
Yes
No
Please list
Are you a U.S. veteran?
Yes
No
Three Personal References (We cannot accept family members as references)
*
Rows
Full Name
E-mail Address
Phone Number
1
2
3
I authorize Circle of Life to perform a background check on me.
*
I agree
I disagree
Are you willing to comply with Circle of Life’s drug-free workplace policy as a condition of your volunteer service?
*
Yes
No
Please verify that you are human
*
Submit
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