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    Volunteer Application for Coming Home Hospice

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    You will be asked for this information on the
    Volunteer Application form for Coming Home Hospice.

    • Name

    • Address, City, State & Zipcode

    • Occupation

    • Home, Work, and Cell Phone number

    • Email

    • Education, Degree, and Major

    • List Volunteer Experiences along with the Dates, Type of Work, and Supervisor/Contact

    • Other Experience

    • Special Skills & Interests

    • Religious/Spiritual Tradition

    • Foreign Language(s)

    • Do you own a Car?

    • Drivers License Number

    • Insurance Company

    • Do you have any health problems? If yes, describe

    • Do you know anyone who works or has worked with hospice programs? If so, who? Name of hospice?

    • Are you grieving a death in the last year?

    • Type of volunteer service you would like to perform: Patient Care, Office, Reception, Massage (must be certified), Kitchen, Notary, Hair/Nails, Other

    • List Availability from Monday to Sunday: Days, Evenings, Weekends

    • How did you hear about us?

    • On a separate document, in essay form, please address the following questions:
      • What has been your experience with serious or terminal illness? how has it affected your life?

      • What are your personal feelings about grief and the grieving process?

      • What are your feelings about HIV/AIDS and cancer? Have these illnesses affected you or someone you love and care for?

      • Do you have any fear of contracting AIDS or cancer by working with residents who have AIDS or cancer?

      • Who are the kinds of patients you anticipate having the most difficulty working with and why?

      • How do you respond to feelings of helplessness in yourself and others?

      • Do you feel you will be able to honor your one year commitment and give the time and energy hospice work requires?

      • What one statement best expresses your desire to volunteer at Coming Home Hospice?
    • Please list two references: Name, Address, Phone number, City/State/Zip

    • List Emergency Contacts: Name, Relationships, Phone Number

    • Signature and Date