Richmond County Hospice
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Richmond County Hospice
Home
About Us
Moments of Life
Managing Grief
Volunteers and Careers
Donate
Events
Make A Referral
Contact
Volunteer Application
Name
*
First Name
Last Name
Birthday
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address
*
Message
*
Phone
*
Please provide us with the best number to contact you at
(###)
###
####
Employer
Occupation
Emergency Contact
*
First Name
Last Name
Relationship To You
*
Emergency Contact Number
*
(###)
###
####
Marital Status
*
Married
Divorced
Widowed
Single
Do you have children?
*
Yes
No
Education
High School Attended, College Attended, Other Special Training
Are you currently in school?
Full Time
Part Time
No
Personal References
Please provide the names and contact information of at least 2 non-family member references.
Areas of Interest
*
Please select the areas you think you'd like to volunteer.
In Home Patient/Family Care
Sitter Service
Nursing Home
Hospice Admin Building
Hospice Haven
Reading/Writing Letters
Bereavement Phone Calls
Bereavement Home Visits
Bereavement Office/Clerical Work
Support Group Co-Facilitator
Light of Life Committee
Administrative Help
Fundraising
Mailings
Special Events
Data Entry
Yard Maintenance
Moving Equipment/Supplies
Painting
Other
Please describe your general health
Great
Good
Fair
Poor
Do you know any other languages?
Do you read/write/speak another language? If so, what languages?
How did you hear about Hospice Volunteering?
*
Why do you want to volunteer?
*
What skills/talents do you feel will make you a good volunteer?
*
What are your thoughts about death?
*
Have you ever been with someone at the time of their passing?
Please describe briefly:
Declaration
*
I hereby certify that the statements made on this form are true and correct to the best of my knowledge. I understand that by submitting I authorize this information to be used by the staff of Richmond County Hospice to verify my employment, character, and records to determine my suitability to volunteer. By typing my FULL NAME below and selecting SUBMIT, I agree to these statements and am ready to volunteer with Richmond County Hospice.
Thank you for submitting this application. Our Volunteer coordinator will be in contact.