We appreciate your interest in serving UNC Health Johnston Homecare and Hospice and/or SECU Hospice House. We are sincerely interested in learning about you. Hospice offers a variety of ways to serve our patients, their families and health care team. Questions on this application are for the sole purpose of considering you for volunteer service. Please answer the questions completely. The starred items are required. Once you complete the form, please read the terms, check the "I agree" box and click the Continue button at the bottom of the page. 


  


Contact Information


Volunteer Interest

Please describe why you would like to volunteer with Hospice. 



Volunteer Experience

Please share any previous volunteer experiences or training that you have had.



Loss of a Loved One/Hospice Care

Have you experienced the loss of a loved one in the last 12 months? Has one of your family members or loved one ever received hospice care? If yes, please briefly describe your experience. 




Current or Past Work Experience

Please enter your present occupation along with your current employer. If you are retired or not currently working, please describe your past work history and the skills/qualifications you would bring to a volunteer assignment. Hospice participates in the "We Honor Veterans" programs and look for volunteers to assist. 




Education

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.



References

Provide the information below for two separate references who have known you for at least two years and who have knowledge of your work habits, skills and compassion . Do not list any relative as a reference. References will either be checked via email or postal mail. To ensure a speedy response, please make sure addresses are complete and accurate.



Availability

Hospice Volunteers typically work 2-3 hour shifts on a weekly basis. Please choose the day(s) and time(s) that you prefer to volunteer.



How did you learn about our hospice program?


Age Requirement

Due to the sensitive nature of volunteering with terminal patients, we require that all volunteers are at least 18 years of age.




Security Information

Questions in this section are asked for the sole purpose of considering you for volunteer service. Your response to any of these security questions will not automatically disqualify you from volunteering. However, if you answer “no” and a criminal history is found, or if you answer “yes” but did not include all convictions, your application will not be considered.  

Have you ever been convicted (pleaded guilty or been found guilty) of a misdemeanor, felony, or other crime? If yes, then list all convictions and provide dates of each.




Authorization & Agreement

UNC HEALTH JOHNSTON’S DEPARTMENT OF HOSPICE SERVICES is committed to a policy of equal opportunity for all applicants regardless of race, religion, national origin, ancestry, sex, sexual preference, age, marital status or disabilities. UNC Health Johnston operates as an at-will organization which means that association can be terminated with or without cause, at any time, by either party, with or without notice, at the option of UNC Health Johnston or at the option of the volunteer. Acceptance as a volunteer is contingent upon satisfactory references and criminal background check and verification of information submitted on this application.

I hereby certify the answers on this application and any given during interviews are true and correct and any misrepresentations or omissions of facts, misleading or false information on my part will be grounds for dismissal as a UNC Health Johnston volunteer. I authorize UNC Health Johnston  to thoroughly investigate the information provided on this application, to conduct a Criminal Background Investigation, and to make such investigations and inquiries as deemed necessary in arriving at a decision to accept me as a volunteer. I will hold no person liable for giving or receiving information in this investigation. I understand that acceptance into the UNC Health Johnston volunteer program is contingent upon satisfactory completion of all pre-placement procedures which include but may not be limited to an interview, verification of references, criminal background investigation, orientation, and vaccination screening. I understand upon both my successful completion of the volunteer placement processes required by UNC Health Johnston and receiving approval for service by Volunteer Services management, I will become a ‘volunteer’ with UNC Health Johnston.