Volunteer Application

Volunteer Application
Applicant Name *
Address *

Address

Street Address Line 2

City State

Zip
Phone *
E-mail Address *
example@example.com
I live in or close to: (please choose all that apply)

Tucson Green Valley Sierra Vista
Person to be notified in an emergency
Name *
Phone *
Address *

Address

Street Address Line 2

City State

Zip
Education/Special Training
Work Experience *
Other special services: (i.e., manicurist, hairdresser, massage therapy)

Yes No
Other special services: (i.e., manicurist, hairdresser, massage therapy)
TWO PERSONAL REFERENCES: (excluding family members
Name of Personal Reference #1 *
Phone for Personal Reference #1 *
E-mail Address for Personal Reference #1 *
example@example.com
Name of Personal Reference #2 *
Phone for Personal Reference #2 *
E-mail Address for Personal Reference #2 *
example@example.com
Are you 16 years or older? *

Yes No
Do you have access to reliable transportation?

Yes No
Do you know a language other than English? *

Yes No
Language #1
Language #1

Speak Read Write
Language #2
Language #2

Speak Read Write
How did you hear about our Hospice Volunteer Program?
Why do you want to be a hospice volunteer?
What qualities (i.e. skills, talents, knowledge and experiences) do you feel you can incorporate into your hospice volunteer work?
What are your thoughts and feelings about death?
Have you ever been with someone at the time of their death?

Yes No
If yes, please describe briefly:
Have you ever provided care to anyone who was dying?

Yes No
If yes, please describe briefly
When thinking of your own death, what words best describe death to you?

I do not think about my own death Sorrowful Natural Frightening Painful Lonely Joyful Peaceful Heavy Dark Other
Comments
Applicant’s Signature

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