Thank you for your interest in volunteering with North Memorial Health Hospice. Volunteers are an important part of our care team, and we appreciate your willingness to consider sharing your time and talents with us.


Please complete this application form if you are interested in becoming a North Memorial Hospice volunteer.


Review the application first to make sure you have all the required information available before you start.


Fill out the application completely as you cannot return to the form to complete it later.


When complete, click the "Continue" button at the bottom.


Name and address


Personal Information

You may optionally provide the following information. Must be 21 years old to volunteer with North Memorial Hospice



Employment


Skills and Experience

What qualities (skills, talents, knowledge, and experience) do you feel you can incorporate into your hospice volunteer work? Check ALL that apply.



Availability


Emergency Contact Information

In the event of an emergency, whom should we contact?



References

Please provide us with 3 people we can contact as references for your volunteer application. At least one reference should be a professional reference which can include a co-worker, supervisor, teacher, mentor, or professor.



Criminal History

If you have ever been convicted of a crime, enter dates and names of convictions. Applicants are not obligated to disclose sealed or expunged records of convictions or arrests. Prior history does not necessarily keep you from becoming a volunteer.



Terms and conditions for applying

Authorized Signature/MN Government Data Practices Act


The Minnesota Government Data Practices Act requires you to be informed that the information on this form in some cases is considered PRIVATE data and may be shared with North Memorial staff, volunteer coordinators, or others with legitimate business needs to access the information. You may refuse to provide any of the data requested on this form; however, refusal may result in denial of your application for volunteer assignment. The data you supply (such as demographic information) may be used in aggregate form (not identifying you individually) for reports and other statistical purposes.


By checking the I Agree box:

* I have read the application instructions and the MN Government Data Practice Act (listed above) related to data privacy.

* I certify that the information in this application is accurate and correct to the best of my knowledge.

* I understand that a passing background check is required

* I authorize North Memorial Hospice Volunteer Services to contact the references I have provided including previous employers/educational institutions. I release North Memorial Hospice from any claims related to contacting these references.

*I understand that volunteers serve at will. North Memorial Hospice, solely at its discretion, determines who serves as a volunteer and may dismiss a volunteer at any time for any reason.

*I also understand that this is not an application for paid employment.

* I understand that if accepted and prior to placement in a volunteer position, I will be required to attend a new volunteer orientation, submit a background study form as required by law, and health-screening.


Volunteer opportunities are provided without regard to religion, creed, race, national origin, age or sex. By checking this box (in lieu of authorized signature) I acknowledge this application for volunteer assignment has been carefully read and understood and I accept the agreements herein.