Thank you for your interest in volunteering with the Hospice Program. Once you complete the form, click the submit button at the bottom. A coordinator will then contact you. All items marked with a * must be completed.
Please include a middle name for the completion of the background check. If you do not have a middle name please enter NMN. Also, please enter a local address and a phone number where you can be reached during business hours.
Please include two, non-family references. We will contact them as part of determining your suitability as a volunteer in our program.
*Your birth date and gender are required for the criminal background check. You may optionally provide the other information.
Please indicate the days and times you are usually available to volunteer.
In the event of an emergency whom should we notify?
Please include your driver's license or state ID for the criminal background check.
This should be a letter followed by 12 numbers.
As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professional in the field in which I work. I, like them, assume certain responsiblities and expect to account for what I do in terms of what is expected of me. I understand that any information that is disclosed to me while assisting Allina Hospice patients is confidential. I interpret "volunteer" to mean that I have agreed to work without compensation of money. If and when I'm accepted as a volunteer worker, I expect to do my work according to the standards set forth in the Volunteer Policies and Procedures.
I understand and agree that submitting this application form does not automatically register me as a Allina Health Homecare Services - Owatonna Area 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. 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 Allina. I understand if I have patient contact I will recieive a one time immunization assessment provided by Allina Health. I affirm that I have read the Volunteer Code of Ethics and agree to abide by its regulation. I agree to respect the confidentiality of any client information I acquire in the course of my volunteer activities with Hospice.