Heart of Ardent – Volunteer Application

The Heart of Ardent

Thank you for your interest in joining the Heart of Ardent.

To be considered to volunteer please fill out the form below.

Volunteer Application

Date
MM slash DD slash YYYY
Name
First Last
Date of Birth
Are you over 18 years old?*
- Yes
- No
Phone
Email
Address
Street Address Address Line 2 City State ZIP Code
Occupation & Briefly Describe What You Do
Employer
Working Hours
Work Phone
Your Availability*
How many hours are you available to volunteer in a week?*
Highest Level of Education
Foreign Languages Spoken
Religious Affiliation
Optional. This assists us in proper placement of our volunteers. We serve patients regardless of religious affiliation.
Why do you wish to be involved in hospice?
What organizations or clubs do you belong to?
Have you had any experience with the terminally ill?
Has someone close to you died within the past year?
What do you like about yourself?
Do you have available transportation for your volunteer work?
Do you have a valid California Driver's License
Do you have automobile liability insurance?
Auto insurance is required if you use your car for hospice work.
Have you been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify you from volunteering.
Experience
Please, list any experiences you believe would be helpful to you in hospice volunteering, i.e. schooling, work, volunteer experience, office skills, arts and crafts, ect.
Areas of Interest
Please check areas of interest
Personal Reference #1:*
First Last
Reference #1 Phone*
Personal Reference #2
First Last
Reference #2 Phone
Emergency Contact
First Last
Emergency Contact's Phone
Physician name
First Last
Physician's Phone
Comments
This field is for validation purposes and should be left unchanged.

Heart of Ardent – Volunteer Application

The Heart of Ardent

Thank you for your interest in joining the Heart of Ardent.

Volunteer Application

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