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:

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:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Gender:

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:

(year optional)

Education:

Marital status:

USA Veteran:

Skills & Experience

In which of these areas do you feel you have moderate to excellent skill? Check all that apply.

Availability

Please indicate the days and times you are usually available to volunteer.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

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.

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:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Cell phone:

Relationship:

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:

Last name:

Home phone:

Work phone:

Cell phone:

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