Please complete this application form if you are interested in becoming a Banner Hospice volunteer. Once you complete the form, check the I Agree box and click the Continue button at the bottom.


Applicant's Information

Provide the following information. An email is required for future communication(s).



Referral Source

How did you hear about Banner Hospice?



Physical and Medical Background Information

Do you have any physical limitations or medical condition that may limit your ability to perform any volunteer duties? If "Yes", please explain below.



Are you a United States Military Veteran?

Banner Hospice has paired with 'We Honor Veterans'; an organization that salutes our Veterans. We are always looking for Veteran Volunteers.


Employment/Experience/Education

Are you, or have you ever been, employed by Banner Health? Please tell us about your previous volunteer experience. What are your hobbies or special skills? Are you currently enrolled in school? Where? What are your areas of study?



Emergency Contact Information

Please provide Emergency Contact Information.



Why Do You Wish To Volunteer?

Please explain why you would like to volunteer:



Background Check

Have you ever been convicted of a felony or a felony that was reduced to a misdemeanor for sentencing purposes including DWI? If yes, state the offense, location, date and disposition.


Availability

If you are interviewed and offered a volunteer position, your availability to serve as a volunteer is very important. Indicate the days and times you are available to volunteer.



Commitment

By checking “I agree” and submitting my application, I am stating that, to the best of my knowledge, all information that I have provided is true and correct.

 I agree to:

  1. Comply with the confidentiality standards regarding all patient information.
  2. Provide my date of birth and social security number to verify and meet Banner Health’s reporting requirement that I have not been excluded from participating in any Medicare, Medicaid or other federal health care procurement program.
  3. Uphold the Mission, Values and Purpose of Banner Health.
  4. Endeavor to serve with compassion, empathy, accountability, responsibility, and excellence.

I understand that my services are donated to Banner Health without contemplation of compensation or future employment and given for humanitarian or charitable reasons. I also understand that there are many types of volunteer opportunities at Banner and that I will be required to complete an initial health screening, background check, orientation and training. I also understand that to continue volunteering, I may be required to comply with additional health screenings and trainings.



Acknowledgement

In submitting this application I agree to the terms outlined in the commitment of services and that all information is accurate.