Kaiser Permanente Northwest -Hospice ONLY- Volunteer Application

Please read this first:

As of March 2020, due to COVID-19, our hospice volunteer program is *on hold* in processing new applications. You may still apply. We will stay in contact with you to let you know when we are able to schedule a new volunteer training. Thanks for your patience.

*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.

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

Personal/Demographic Information

Employment History

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

1

2

Employer name:

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Work phone:

Cell phone:

Email address:

Relationship:

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

Educational Background

Questionnaire

Tell us about yourself:

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.

1

2

Employer name:

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

Verified:

3

Employer name:

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Email address:

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