Volunteer Application

Name

This field is for validation purposes and should be left unchanged.

PLEASE READ BEFORE COMPLETING THIS APPLICATION

This company does not discriminate in the recruitment, hiring, and conditions of employment (volunteering) based on race, color, religion, national origin, sex, disability, age, or veteran status and any other applicable laws. Your completed application will be reviewed carefully. However, applying for Volunteer opportunities does not guarantee acceptance into this program. Volunteer consideration necessitates that you meet all minimum qualifications and requirements for the applied position.

Personal Data

Name(Required)

Sex

Phone / Cell # Please specify if cell or landline/include area code(Required)

Street Addres

State

City

Zip

Email(Required)

Employer

Employment Type

Full Time

Part Time

Other

Employer Address

Business Phone #

Contact Email

If retired, please specify your background

General Information

How were you referred to our company?

Specific name of referral source indicated above, if applicable

When you are available to volunteer?(Required)

Weekday

Weekend(s)

School Year

Other

Education

Other Education

Previous Volunteer Experience

Organization

Type of Work

Reason for Leaving

Organization

Type of Work

Reason for Leaving

References

Reference 1 Name

Address

Phone/Cell #

Relationship (check all that apply)

Reference 2 Name

Address

Phone/Cell #

Relationship (check all that apply)

Reference 3 Name

Address

Phone/Cell #

Relationship (check all that apply)

Volunteer Position Preferred

Please check boxes of interest(Required)

Other Preferred Position

Additional Information

Do you speak a foreign language?

Yes

If yes, specify:

Are you an active service member/Veteran?

Yes

If yes, specify:

Other skills and interests

Code of Ethics for Volunteer

As a Volunteer, I realize I am subject to a code of ethics much like those which binds the professional in the field in which I work. I, like them, assume accountability for my work and will seek to fulfill my responsibilities to the best of my ability.

I understand that any information disclosed to me while assisting Swan Hospice is confidential. I interpret my role as Volunteer to mean that I have agreed to work without monetary compensation.

Having been accepted as a Volunteer, I will do my work according to the standards set forth in the Volunteer Orientation Manual and description.

I agree to a background investigation.

Declaration

I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that by submitting this application and consenting for a background investigation I am authorizing inquiries to be made concerning my employment, character, and public records for the sole purpose of determining my suitability as a Volunteer.

I agree to abide by the Volunteer Code of Ethics and to respect the confidentiality of any patient or family during my Volunteer activities with

Name(Required)

Signature(Required)