Please complete this application form if you are interested in becoming a Parkview Hospice Volunteer. Once you complete the form, click the Continue button at the bottom.


Contact Information


Demographics


References

Please provide two NON-FAMILY MEMBER references that we may contact. NOTE: Valid references (including complete addresses) MUST be included in this field for application to be processed. To expedite the reference process, please provide a valid email address for both of your references.



Emergency Contact

In the event of an emergency whom should we notify?



Why Parkview Hospice?

1. What makes you interested in volunteering with Parkview Hospice? 

2. What skills do you have that you think would fit with our program?



Criminal Background History

NOTE:  A conviction will not automatically disqualify you from volunteer placement at Parkview Health. Any misrepresentation will disqualify you from a volunteer position. Please list prior convictions below.



I Agree

I certify that the information in this application (and any accompanying documents) is true. I understand that falsification of any information in this application, discovered at any time before, during, or after I begin my position as a volunteer may lead to my termination.


I hereby authorize Parkview Health (Parkview Home Health & Hospice) to verify, obtain copies of records and gather any information pertaining to my submitting a volunteer application with Parkview Home Health & Hospice. My signature on this application authorizes Parkview Health (Parkview Home Health & Hospice) to request written verification as needed.


The receipt of this application does not imply that I will be offered a position as a volunteer. If accepted as a volunteer, I agree to comply with established rules, policies, procedures and Parkview Health Standards of Behavior. This includes but is not limited to those which relate to confidentiality, employment and universal precautions.


I understand my volunteer position with Parkview Home Health & Hospice means volunteering at Parkview's discretion; my volunteer position can be terminated at any time with or without cause, and with or without notice at the option of Parkview Health or myself.


Parental/Guardian permission is required for volunteers under 18 years of age. By submitting this form, I confirm that I am 18 years of age, or that I have parental/guardian permission to apply to be a volunteer at Parkview Health.


It is the policy of Parkview Health to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual orientation, expression of gender identity, age or disability.


Thank you for completing this form and for your interest in volunteering with us!