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.
Name*

First nameLast name
Address*

Street Address

Street Address Line 2

CityState

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

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

EmailMailPhone
Date of Birth

MonthDayYear
Date
Are you under age 18?*

NoYes
How did you hear about Gulfside?*
Background Screening Information: (18 and older only)
Country/Citizenship:
SSN
Driver’s License:
State Issued:
Sex
Race
Height
Weight
Eye Color
Hair Color
Place of Birth:
Maiden Name:
Emergency Contact Information:
Contact Name*
Relationship*
Contact Phone Number*
Please enter a valid phone number.
Volunteer History
Are you currently volunteering at another hospice?

YesNo
Do you have previous volunteer experience with Gulfside?

YesNo
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 TimeEmployed Part TimeSelf EmployedRetiredNot employed
Education Status

Some or no High SchoolHigh School GraduateCollege DegreeSome College/Certification/Technical SchoolPostgraduate Work
Field of Education Study (if applicable)
Skills:
Do you know a foreign language?

YesNo
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?

YesNo
Are you currently in the Armed Forces?

Yes - Full TimeYes - ReservesRetiredNo
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:

MonthDayYear
Date
Date of your last flu vaccine:

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

YesNo
What areas of volunteer opportunities interest you? (Check all that apply.)*

Office SupportGrief Support/Bereavement ServicesAdministrative/Data EntryPatient Care/Companionship/RespitePatient Care - In-Patient Centers/FacilitiesVeteran's ProgramReception/GreeterGift of PresenceZephyrhills Care Center KitchenGrocery Shopping/Errand RunningSpiritual Care VolunteerCommunity Awareness/Special Events/Health FairsPet Peace of MindPatient And Caregiver Telephone Support (PACTS)Thrift Shoppes (if selected, please select preferred store below)If other, please explain:
Thrift Shoppes:

New Port RicheyHudsonDade CityZephyrhills
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. I attest that the information above is true and factual and that it was completed in its entirety, by me, for the purpose of background screening clearance to Volunteer with Gulfside Hospice.
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
Please verify that you are human*
Should be Empty:

Thank you for your interest in becoming a Gulfside volunteer!

Background Screening Information: (18 and older only)

Emergency Contact Information:

Volunteer History

Skills:

Armed Forces or Veterans Status:

Physical Health:

AGREEMENT