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


NAME AND ADDRESS


DEMOGRAPHIC INFORMATION

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.



PHYSICAL/MEDICAL BACKGROUND


IN CASE OF EMERGENCY


EMPLOYMENT/EXPERIENCE/EDUCATION


SERVICE WITH BANNER


WHY DO YOU WISH TO VOLUNTEER?


AVAILABILITY

During which months, days and hours are you available for volunteer assignments?



COMMENTS


VOLUNTEER COMMITMENT TO SERVICE & CONFIDENTIALITY

Believing that Banner Homecare & Hospice has a genuine need for my services as a volunteer, I agree to:

(1) Maintain confidentiality of all information which I may obtain directly or indirectly concerning patients, physicians, or personnel;

(2) Provide excellent volunteer service. I understand that my services are donated to Banner Homecare & Hospice and that I will receive no compensation or promise of future employment;

(3) I verify the information on this application is true. I understand that I will be required to complete an orientation, health screening, and criminal background check.



Agreement

I understand that this is a voluntary service. By signing below, I accept and agree to comply with the policies, rules, and regulations of the Banner Homecare and Hospice Volunteer Services Department.