Hoffmann Hospice: Volunteer Application

Volunteer Application

Become a valued member of our team by volunteering at Hoffmann Hospice, where your compassion and time can make a significant difference in the lives of our patients and their families.

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Are you 16 years of age or older?

Name

First

Last

Work Phone

Home Phone

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employment / Work History

Current Employer

Job Description

Education

Currently Attending School

Do you have Future schooling plans?

College Attended / School Attending

Year Graduated / Expected Graduation Year

Personal References

Reference 1

Name

First

Last

Hospice screening Job

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Reference 2

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Reference 3

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Emergency Contact

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Do you have a reliable means of transportation?

Do you have Liability Insurance?

Volunteer Availability

Daytime
Evenings
Weekends

(Select all that apply)

Relevant Background

Have you had a personal experience with terminal illness or death within your immediate family in the past year?

If yes, please explain.

Have you experienced any deaths in your family or of those close to you?

How did you hear about Hoffmann Hospice?

Why do you want to volunteer for Hoffmann Hospice?

Have you received hospice training previously? If yes, where and when?

Are you a Veteran? If so, what branch of the military?

Health Status

Describe your health

Good
Fair
Poor

Have you received a Tuberculosis (TB) screening within the past 90 days?

Interest: Interpreting

Please list any languages you write or speak

Interest: Music

Please Name Instrument

Interest: Professional Skills

Please list any professional skills

Interest: Administrative Skills

Please list any administrative skills

Are you able to make a six-month to one-year commitment to Hospice volunteering?

Please list any special hobbies, talents, or services you would be willing to share:

In submitting my application as a prospective volunteer for Hoffmann Hospice, I authorize the agency to contact employers and references provided and to gather other information as appropriate to determine my suitability to serve in such a capacity.

Name

First

Last

Date / Time

Your Comfort is Our Priority

Our team is available 24/7 to answer your questions, and ensure all your hospice care need are met with empathy and expertise.

Providing compassionate care and support to patients and families throughout life’s final journey. Hoffmann Hospice – Where care meets comfort.

Volunteer Application

Volunteer Application

Become a valued member of our team by volunteering at Hoffmann Hospice, where your compassion and time can make a significant difference in the lives of our patients and their families.

Employment / Work History

Education