Nickname (if applicable)
Phone (best number to reach you)
Birthday (just month and day)
Home Address (Street, City and Zip)
Employer and Occupation
Best way to contact (weekday/daytime)
Areas of Volunteer Interest (select all that apply)
Best Days to Volunteer (select all that apply)
Best Times to Volunteer (select all that apply)
Please provide two personal references. Include name, phone, email and relationship. (Non-family members only please)
Why do you want to be a hospice volunteer?
What personal characteristics will enable you to work with people who are facing a terminal illness?
Please describe any work or other experiences which you feel have prepared you to be a Patient Care Volunteer
List any special skills, hobbies, talents that could be incorporated with your Patient Care Volunteering
(manicurist, hairdresser, massage therapist, music, writing, arts and crafts, etc,):
Do you know any language other than English?
If yes, please specify (Speak, Read, Write)
DEATH & DYING
How long ago was the last death that impacted you, and what was the relationship?
What are your experiences with terminal illness and death?
What are your thoughts and feelings about death?
How did you hear about Tranquil Care Hospice?
Please list any dietary restrictions (vegetarian, lactose intolerant, food allergies etc.)
By checking this box, I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that, by submitting this application I authorize inquiries to be made concerning my employment, character and public records for the purpose of determining my suitability as a volunteer.
Signature (complete your full name)