29826 Haun Road, Suite 108, Sun City, CA 92586
Phone: 951.679.8872 FAX: 951.679.7882
Thank you for your interest in becoming a hospice volunteer. Please complete both sides of this application and return it to the address listed.
Name (Last, First, MI)
Are you over 18 years old?
City, St, Zip:
Briefly describe the type of work you do:
Total number of hours per week you could be available for hospice volunteering:
Level of Education:
2 Year College
4 Year College
Foreign languages spoken:
RELIGIOUS AFFILIATION (optional -- this assists us in proper placement of our volunteers. We serve patients regardless of religious affiliation)
How did you hear about us?
Why do you wish to be involved in hospice?
What organizations or clubs do you belong to?
Have you had any experience with the terminally ill?
Has someone close to you died within the past year?
What do you like about yourself?
Do you have available transportation for your volunteer work?
Do you have a valid California driver's license?
Do you have automobile liability insurance?
(Auto insurance is required if you use your car for hospice work)
Have you been convicted of a felony within the last 7 years?
(Conviction will not necessarily disqualify you from volunteering)
List experiences you believe would be helpful to you in hospice volunteering, i.e., schooling, work, volunteer experience, office skills, arts and crafts, etc.
AREAS OF INTEREST:
(Please check areas of interest)
Patient and/or family visits
Relieve primary caregiver
Read to patient
Music or entertaining
Host/hostess for hospice events