Hospice Volunteer Application

Hospice Volunteer Application
Hospice is a special way of caring for the terminally ill and their caregivers. Focusing on the whole person and not the disease, Hospice strives to take care of the patient's physical, emotional, social and spiritual needs, as well as the needs of the family. Hospice takes a team approach with each member of the team, offering a specific set of skills.

Volunteers are an integral part of the hospice program. Each volunteer is specially trained in the hospice philosophy, goals and areas of care that are consistent with the tasks they perform. Services include:

·         Reading to patients

·         Visiting patients

·         Running errands

·         Spiritual support

·         Respite care

·         Office tasks

Hospice is a very different area of Healthcare and not a comfortable or suitable fit for everyone, especially if you’ve lost someone in the last year, but can be very rewarding for the patient, caregiver, family, and volunteer.
Are you a student needing to complete community service hours?

YesNo
How Many?
When do you need the hours completed by?

MonthDayYear
Date
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Email Address:
Are you at least 18 years or older?

YesNo
Times Available

DaysEveningsWeekends
Availability

Year RoundSpringSummerFallWinter
Date Available to begin

MonthDayYear
Date
Counties You are Willing to Volunteer In:

ClarkeCovingtonForrestGeorgeGreeneHancockHarrisonJasperJefferson DavisJonesLamarLawrenceMarionPearl RiverPerrySimpsonSmithStoneWalthallWayne
Areas of Interest Check all that apply

Reading to patientsRelief visitsAssisting with lettersAssisting with callsTypingFilling/MailingsFundraisingSpeaking Engagements
Provide (2) References: No Relatives
Reference - 1
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Email
example@example.com
Relationship
Provide (2) References: No Relatives
Reference - 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Email
example@example.com
Relationship
Current Employer & Occupation:
How did you learn about this opportunity?

Forrest Health EmployeeForrest Health VolunteerPrior Visit to a Forrest Health FacilitySchoolWebsiteEmployeeOtherOther
If other how did you learn about us?
Name of employee/volunteer referred by:
Are you a former Forrest Health Employee or volunteer?

YesNo
Do you currently have relatives who are employed at Forrest Health?

YesNo
If yes who and in which department?
Which location are you interested in?
The Volunteers do not conduct any direct patient care.
Background/Preferences
Why do you want to be a hospice volunteer
Please list any preferences/sensitivities you may have (ie, allergic to pets, etc)
Have you ever provided care to anyone who was dying

YesNo
In the last year?

YesNo
Would you like to receive occasional electronic communications via Forrest Health's Marketing Department?

YesNo
Email
example@example.com
Signature

Clear
Email
example@example.com
Should be Empty: