Gulfside Hospice Volunteer Application

Thank you for your interest in becoming a Gulfside volunteer!
Please complete this form and it will be sent to Gulfside's Volunteer Department. Once received, our team will contact you shortly.

A downloadable PDF version of the application is also available. CLICK HERE to download the pdf. If downloading the form, please complete it, then send it to volunteerrecruiter@gulfside.org.

Please note: A clean background check without a misdemeanor or felony is necessary to become a volunteer. Applicants under age 18 will NOT be subject to a background check.

For questions or assistance with the application, please contact Gulfside's Volunteer Department at 727-845-5707.
Date

Month Day Year
Date
Name *

First name Last name
Address *

Street Address

Street Address Line 2

City State

Zip Code County
Cell Phone *
Home Phone
Email *
example@example.com
Florida Resident *

Permanent Seasonal
Dates in Florida (If Seasonal)
Preferred method of communication *

Email Mail Phone
Are you under age 18? *

No Yes
How did you hear about Gulfside? *
Emergency Contact Information:
Contact Name *
Relationship *
Contact Phone Number *
Please enter a valid phone number.
Volunteer History
Are you currently volunteering at another hospice?

Yes No
Do you have previous volunteer experience with Gulfside?

Yes No
Why are you interested in volunteering with Gulfside Hospice?
Have you experienced any deaths in your family, or someone close you?
Employment Status

Employee Full Time Employed Part Time Self Employed Retired Not employed
Education Status

Some or no High School High School Graduate College Degree Some College/Certification/Technical School Postgraduate Work
Field of Education Study (if applicable)
Skills:
Do you know a foreign language?

Yes No
If yes, please specify language(s)
Please list special skills and/or hobbies you have:
What organizations do you belong to (if applicable)?
Armed Forces or Veterans Status:
Have you ever served in the Armed Forces?

Yes No
Are you currently in the Armed Forces?

Yes - Full Time Yes - Reserves Retired No
If yes, please specify branch.
Physical Health:
All volunteers working in a patient care related area must provide proof of annual TB Test and annual Flu Vaccine. If annual Flu Vaccine is declined, volunteer must wear mask when working in patient related areas.
Date of your last TB Test:

Month Day Year
Date
Date of your last flu vaccine:

Month Day Year
Date
Do you have physical restrictions that might limit your volunteer placement in specific areas within Gulfside?

Yes No
What areas of volunteer opportunities interest you? (Check all that apply.) *

Office Support Grief Support/Bereavement Services Administrative/Data Entry Patient Care/Companionship/Respite Patient Care - In-Patient Centers/Facilities Veteran's Program Reception/Greeter Gift of Presence Zephyrhills Care Center Kitchen Grocery Shopping/Errand Running Spiritual Care Volunteer Community Awareness/Special Events/Health Fairs Pet Peace of Mind Patient And Caregiver Telephone Support (PACTS) Thrift Shoppes (if selected, please select preferred store below) If other, please explain:
Thrift Shoppes:

New Port Richey Hudson Lutz/Land O Lakes Dade City Zephyrhills
AGREEMENT
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this Volunteer Application as deemed necessary for volunteer participation. I understand that this application is not and is not intended to be an offer of employment. In consideration of being a Gulfside Hospice volunteer, I do hereby assume the risk of injury and all medical expenses incurred from any injury resulting from my volunteer participation. I understand, acknowledge and agree I am not covered by Workers' Compensation Insurance or benefits provided there under and I do hereby release, discharge, and hold harmless Gulfside Hospice, its agents, representatives, and employees from any and all claims whatsoever, known or unknown, for damages or injuries to myself.
Applicant Print Name *
Applicant Signature & Date *

Clear
Parent/Guardian Print Name (If applicant is under age 18)
Parent/Guardian Signature & Date (If applicant is under age 18)

Clear
Should be Empty:

Thank you for your interest in becoming a Gulfside volunteer!

Emergency Contact Information:

Volunteer History

Skills:

Armed Forces or Veterans Status:

Physical Health:

AGREEMENT