Volunteer Application Form

Please complete this application form if you are interested in becoming a volunteer for Rainbow Hospice or Friends in Actin You can learn more about volunteering on our website - rainbowhospicecare.org/index.php/volunteer.

Proof of COVID vaccination is required in order to volunteer.

Once you complete the form, click the Continue button at the bottom.

General Information

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Date of birth:

Gender:

Education:

Military Veteran:

Are you currently employed?:

Volunteer Experience:

Emergency Contact

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Relationship:

References

We request a minimum of two references but recommend more. Email is the best way to contact references.

1

2

First name:

Last name:

Home phone:

OK to call here

Home phone:

OK to call here

Cell phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

3

First name:

Last name:

Home phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Please make sure that your references are aware that a reference form will be sent to their email via DocuSign. We will need at least two completed reference forms returned to us in order for you to start volunteering.

Volunteer Opportunities & Interests

This is just an initial list, but please select any tasks you may be interested in assisting with.

How did you hear about volunteering at Rainbow?

1

List any training/education that you have had in the healthcare field.

2

Describe any personal experience you have had with someone who has a chronic/serious illness or dementia.

3

How do you handle stress?

4

Describe your support system

5

Have you experienced any significant losses within the past year? If yes, would you be willing to describe it and your reaction to it?

6

List any health concerns or physical limitations that we should be aware of

Background Checks

It is policy of Rainbow Hospice Care to run background checks on all volunteers. If you have ever pleaded guilty to or been convicted of a felony or a misdemeanor (exclude minor traffic offenses), please describe in the text box below. Please explain when and where the offense occurred and describe your conduct.

Sharing you have pleaded guilty to or been convicted of a felony or a misdemeanor (excluding minor traffic offenses) does not automatically disqualify you from becoming a volunteer.

Signature

I certify that the information in this application is correct to the best of my knowledge and belief. I authorize agents of Rainbow Hospice Care to check the references I provided and check with the appropriate public authorities regarding my background and history. I understand that should I be offered a volunteer position, any misrepresentation by me may lead to termination. I also understand that either Rainbow Hospice Care or I can terminate my volunteer service, with or without cause and/or notice, at anytime. If accepted, I will abide by the rules and regulations of Rainbow Hospice Care. I understand that completing the application process does not guarantee acceptance as a volunteer.

I Agree

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