Please complete this application form if you are interested in becoming an Office/Support volunteer, weekdays between 8am - 5pm, at our Westgate office, 1055 Westgate Drive, Suite 100, St. Paul MN 55114. Once you complete the form, click the submit button at the bottom. All items marked with an * need to be completed.

Contact information

Please enter a local address and phone number where you can be reached during business hours.

First name:

Last name:

Title:

Street 1:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Date of birth:

Refer/source:

Employer name:

Work phone:

OK to call here

Contacted:

Verified:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

City:

State:

Zip:

Home phone:

OK to call here

Work phone:

OK to call here

Relationship:

References

Please include two personal (non-family) references. We may contact them as part of determinging your suitablitity as a voluneer in our program.

1

2

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

OK to call here

Home phone:

OK to call here

Work phone:

OK to call here

Work phone:

OK to call here

Email address:

Relationship:

Contacted:

Verified:

Skills

Please enter any skills or areas of interest you have.

List any office skills and/or computer programs you are familiar with. Include any interests you may have for fundraising or public speaking or foundation work.

Criminal Background Check

Please include your driver's license number for the criminal background check and any alias that you have used. (i.e. maiden name)

Declaration

I hereby certify that the statements made on this appliction 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. I understand that I will undergo a criminal background check paid for by Hospice and authorize it by checking the agree box. I agree to respect the confidentiality of any client information I acquire in the course of my volunteer activities with Hospice.

I Agree