Kaiser Permanente Northwest -Hospice ONLY- Volunteer Application

Please read this first:

*This application is to apply for the Hospice (end of life service) volunteer program ONLY.

**You must be over the age of 21 to apply.

***Note that Kaiser Permanente NW Hospice serves the greater Portland Metro Area and Clark County WA. This application is not for out of area applicants.

Hospice - is a specific program for patients who have a terminal diagnosis of 6 months or less, and volunteers work with patients and families at the end of life.

Kaiser Permanente Hospice Program is not a facility nor is it located in either Kaiser hospitals.

A hospice volunteer's primary purpose is to provide in-home respite care for a family caregiver (give the caregiver a 4 hour break). Hospice volunteers are also "friendly visitors," visiting our patients living in community facilities. Volunteers are assigned to one patient at a time, making a weekly commitment that lasts the whole time a patient is on hospice.

This is just the first step. You will need to pass a drug screen and criminal background check before we can enroll you in a 16 hour hospice volunteer training. This training is offered quarterly.

If you have any questions regarding our program, call our Volunteer Program directly at 503.499.5168 or email hospicevolunteernw@kp.org

Thank you.

Personal/Demographic Information

Employment History

Tell us your most recent employer and/or volunteering history.

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Employer name:

First name:

Last name:

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Work phone:

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Relationship:

Tell us about your work or volunteer experience(s). What is your goal for hospice volunteering?

Educational Background

Questionnaire

Tell us about yourself:

How did you become interested in hospice volunteering?

References

Include two work references and one personal reference. All references will be contacted after the personal interview. Be sure to notify your references they will be contacted by Hospice. Thank you.

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Employer name:

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Home phone:

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Verified:

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Employer name:

First name:

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Street 1:

City:

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Home phone:

Work phone:

Cell phone:

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Relationship:

Verified:

I am applying to be a volunteer with the Kaiser Northwest Hospice program. I understand I must be 21 and over to apply.

I agree that the information is true and correct to the best of my ability.

I Agree