Big Bend Hospice Volunteer Application Form

Thank you so much for your interest in volunteering with our organization.

We rely on volunteers in a variety of roles, based on your interest and our requirements.

We keep applications on file for six months.

Contact Information

First name:

Last name:

Nickname:

Physical or Mailing Address:

apt #:

City:

State:

* Zip: *

Home phone:

Cell phone:

Preferred Email:

County:

How did you hear about volunteering with BBH?

Hospice experience, hospice volunteer, brochure, newspaper, social media, presentation, community event, faith community, school/university... please be specific if possible.

Demographics

Please provide the following information as it is used to help us get a better idea of the demographic make-up of our volunteers.

Birthday:

Age range:

Gender:

Lifestyle:

Military Branch:

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. This can be updated at any time via the volunteer portal.

Tell Us...

What you know about hospice care, why you are interested in our organization, the type of role you are seeking, and what you hope to contribute and gain from your involvement.

Are you...

Willing to work with people without regard to race, gender, age, sexual orientation, religious creed, disability or marital status?

Able to commit to volunteering for a minimum of 1 year?

Willing to take a the required level 2 background screen?

Willing to take the required 2-step TB screening?

And do you have reliable transportation?

Type YES or NO Below. If NO, please elaborate.

Has anyone close to you died within the last year?

Type YES or NO below. If YES, please elaborate.

Please Describe your

Volunteer Experience, past or current.

Please Describe your

Professional Experience or Academic Education

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Cell phone:

Relationship:

References

Who can we call for a reference check? *Cannot be a relative

Primary phone:

First name:

Last name:

Street 1:

City:

State:

Zip:

Relationship:

I Agree

I understand and agree that submitting this application form does not automatically register me as a Big Bend 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 and agree that submitting this application form that if I am approved as a Big Bend Hospice volunteer I choose to serve without expectation of any monetary compensation, and I will be considered an unpaid employee of Big Bend Hospice. I also understand that as an unpaid employee of Big Bend Hospice I am not eligible for worker’s compensation in the event of injury or illness that may result from my activities as a Big Bend Hospice volunteer.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree