Volunteer Application Form
Please complete this application form if you are interested in becoming a Faith Presbyterian Hospice volunteer. Once you have completed the form, click the submit button at the bottom. You must be 18 years of age or older to volunteer at Faith Presbyterian Hospice.
Volunteering Site Location
Are you interested in volunteering only at our INPATIENT facility (located near the intersection of highways 75 and 635 in Dallas), only HOME HOSPICE (private homes/facilities around the metroplex), or BOTH?
Site Location:
Choose
Both
Faith Home Hospice
Simmons Inpatient Center
*
If you will be volunteering for HOME HOSPICE out in the community, which areas/cities are you willing to travel to? Faith Hospice covers 5 counties, so please be specific (ie, Plano, Irving, Collin County, Oak Cliff, etc.)
Contact Information
First name:
*
Last name:
*
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
*
Street 2:
City:
*
State:
Choose
TX
*
Zip:
*
Home phone:
OK to call me here
Cell phone:
OK to call me here
Email address:
Gender:
Choose
Female
Male
*
Why do you want to volunteer at Faith Presbyterian Hospice?
Referral Source
How did you hear about Faith Presbyterian Hospice? Please be specific (ie, Voly.org, VolunteerMatch.com, Faith's website, School Counselor - JJ Pearce HS, my friend John Smith, etc.)
Referral Source:
*
Yes or No: are you volunteering for school/internship credit? If Yes, please explain the program and time constraints.
Demographics
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers. Please select the highest Education achieved.
Date of birth:
Month
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1918
(year optional)
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
Marital status:
Choose
Divorced
Married
Single
Widow/widower
USA Veteran:
Choose
No
Yes
*
Skills & Experience
In which of these areas do you feel you have moderate to excellent skill? Check all that apply.
College Attended:
Skills:
Arts and crafts
Chinese speaking
Copier
Customer service
Data entry
Experience with video/audio recording
Filing
Interacting with patients
Microsoft Office (Word, Excel, etc.)
Phone/reception
Retail experience
Scanners
Sewing skills
Spanish speaking
What previous volunteer and/or work experience do you have?
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
From:
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Assignment Preference
The following volunteer assignments may currently be available. You may click the assignment names to learn more about that assignment. Use this list to choose your top three assignment choices.
Please know that we do not currently have any positions open with direct patient contact, with the exception of Pet Therapy.
Assignment Preference:
Bereavement Calls - Seminarians [Faith Presbyterian Hospice\Bereavement Program]
Camp Faith [FPH Extended\Camp Faith and Faith Kids]
Faith Kids [FPH Extended\Camp Faith and Faith Kids]
Faithful Paws [Faith Presbyterian Hospice\Innovative Program]
Floor Concierge [Faith Presbyterian Hospice\Inpatient - Simmons Inpatient Center]
Greeter [Faith Presbyterian Hospice\Inpatient - Simmons Inpatient Center]
Photo Collage [FPH Extended\Extended Services]
School Work/Orientation - Seminary Interns [FPH Extended\Extended Services]
Seminary Intern - Admin [Faith Presbyterian Hospice\FPH Office]
Winter's Candlelight Memorial [FPH Extended\Special Events]
Criminal History
Have you ever been arrested and/or convicted of a felony? Please explain.
Emergency Contact
In the event of an emergency whom should we notify?
1
2
First name:
*
First name:
*
Last name:
*
Last name:
*
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
Street 1:
Street 2:
Street 2:
Street 3:
Street 3:
City:
City:
State:
Choose
TX
State:
Choose
TX
Zip:
Zip:
Home phone:
Home phone:
Cell phone:
Cell phone:
Relationship:
Choose
Co-worker
Daughter
Family
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
Relationship:
Choose
Co-worker
Daughter
Family
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
References
Please list two people who can provide a character reference for you. DO NOT include immediate family members. Options include: supervisors, coworkers, friends, pastors, teachers, etc.
1
2
First name:
*
First name:
*
Last name:
*
Last name:
*
Home phone:
Home phone:
Work phone:
Work phone:
Cell phone:
Cell phone:
Email address:
Email address:
Physical/Mental Limitations
Do you have any physical or mental limitations (ie, limited hearing, uses a walker, dyslexic, etc.)? Please explain.
I Agree
I understand and agree that submitting this application form does not automatically register me as a Faith Presbyterian 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.
I understand that if I become a volunteer with Faith Presbyterian Hospice, I will have to submit to a background check, drug testing, and annual TB test (at no cost to the volunteer.) I also understand that becoming a volunteer is contingent upon completion of one or more orientation/training sessions. To remain an active volunteer, I will complete additional continuing volunteer education as needed.
I agree that if I am a teen volunteer, I must commit to at least 50 hours of service. If I am an adult volunteer, I must commit to a minimum of 1 year of volunteer service.
By submitting this form, I attest that the information I have provided on the form is true and accurate.
I Agree
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