Mt Evans Home Health & Hospice Volunteer Application Form

We appreciate your interest in volunteering for Mt Evans Home Health & Hospice. Please complete this application form if you are interested in becoming a Mt. Evans Home Health and Hospice volunteer. Once you complete the form, click the submit button at the bottom of the page. You will be contacted by a Volunteer Services Staff member soon. Thank you!

Personal Information

Please enter your personal and contact information. The fields with an asterisk are required. In order to maintain high standards and protect our patients, we do background checks on all volunteers. All information will be kept confidential and only used to complete the application process.

Availability

Please indicate the days and times you are usually available to volunteer.

Demographics/Employer Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

**You must be at least 16 years old to volunteer.

Education:

Employer name:

Street 1:

Street 2:

City:

State:

Zip:

Work phone:

Please list any professional affilitations or applicable licenses you have.

Assignment Preference

The following volunteer assignments may currently be available. You may click the assignment names to learn more that assignment. Use this list to rank your top three assignment choices.

Volunteer Experience

Please tell us about your most recent volunteer experience.

Please list your most recent volunteer experience. Include the agency name, dates and description of volunteer work.

General Information

Please tell us a little more about yourself by answering the following questions

Where did you hear about Mt. Evans Home Health and Hospice? Why are you interested in volunteering with Mt. Evans?

Emergency Contact

Please provide contact information in case of emergency.

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Relationship:

References

Please list three people we may contact for a personal or professional reference.

1

2

First name:

Last name:

Home phone:

Cell phone:

Email address:

Relationship:

3

First name:

Last name:

Home phone:

Cell phone:

Email address:

Relationship:

Email

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

What kinds of email would you like to receive?

Electronic newsletters
Bi-weekly newsletter about the organization.

Recruitment appeals
Weekly information about open volunteer positions.

Volunteer Team Updates
Emails sent out to specific volunteer teams.

Schedule reminders
Email reminder about your volunteer schedule.

Checklist reminders
Email reminder about required items you need to complete.

I Agree

I understand and agree that submitting this application form does not automatically register me as a Mt. Evans Home Health and Hospice volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

Mt. Evans Home Health & Hospice policies do not allow discrimination on the basis of race, national origin, religion, age, sex, marital status or a disability. No question on this application is intended to secure information to be used for such discrimination.

I Agree

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