Volunteer Application

Hospice volunteers experience unforgettable moments of compassion and fulfillment as they enhance the lives of those facing their end of life journey. The support our volunteers provide to the patients we serve and their caregivers is immeasurable. If you are called to join our volunteer team, please complete the application below and we will be in touch within 1-2 weeks.

PLEASE NOTE: Due to the ongoing COVID-19 pandemic, patient companionship visits are currently on hold due to Hospice of Davidson County’s policies to promote health and safety for all staff, volunteers, patients and families. However, the need for administrative assistance, phone support, and remote opportunities still remain.

Volunteer Application
Please complete this application to become a registered volunteer with Hospice of Davidson County. One of our volunteer coordinators will reach out to you after your application is processed. Thank you for your desire to volunteer your time with us!
Name*
Title First Middle Last Suffix
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Enter Email Confirm Email
Do you have a valid NC driver's license?*
- Yes
- No
If yes, please list driver's license number.
How Did You Hear About Our Volunteer Opportunities?*
- Referral
- Internet Search
- Internet Ad
- Print Ad
- Facebook Post
- Other
Emergency Contact Information
Name
First Last
Relationship
Phone
If you are under 18 years of age, please enter your parent/guardian name and number.
Name
First Last
Phone
Volunteer Experience
Please list previous volunteer experience (organization, location, dates, hours served, and what you did).
Please list organizations, churches or clubs in which you are active.
Have you ever been convicted of any unlawful offenses, other than minor traffic violations?
- Yes
- No
If yes, please explain in detail.
Education & Speciality Training
High School*
City, State
Did you graduate?
- Yes
- No
Community College, College or University*
City, State
Did you receive a degree or certificate?
- Yes
- No
If so, what type of degree did you receive?
Graduate/Professional College or University*
City, State
Did you receive a degree or certificate?
- Yes
- No
If so, what type of degree did you receive?
Are you attending school now?
- Yes
- No
Expected Graduation Date
MM slash DD slash YYYY
Course of Study
Special Services & Complimentary Therapies
Please check all services or therapies in which you have experience.*
- Music
- Pet Therapy
- Aroma
- Art
- Massage
- Hairdressing
- Manicurist
- Reiki
- Relaxation
- Healing Touch/Hands of Light
- Other
Areas of Interest, Availability and Skills
Please select your areas of interest in providing Direct Patient Family Care.*
- Private, residential home
- Nursing facility
- Assisted living
- Hinkle Hospice House
- Errands
- Meal delivery
- Complimentary therapies
- Companionship
- Respite care
- Light housekeeping
Please select all you are interested in with Grief Support and Bereavement.*
- Making phone calls
- Home visits
- Support groups
- Transportation
- Administrative support
Please select areas of interest in Non-Direct Patient Services.*
- Clerical support
- Fundraising
- Mailings
- Marketing
- Courier
- Events
- Crafts
- Birthday cake provider
- Data entry
- Answering phones
- Outreach and public speaking
Please select areas of interest in Non-Direct Patient Services.*
- Weekdays mornings
- Weekday afternoons
- Evenings
- Weekends
Are you available on short notice?
- Yes
- No
Are you willing to commit to volunteering at Hospice of Davidson County for a minimum of one year?*
- Yes
- No
Do you have access to transportation?*
- Yes
- No
Do you currently have an immediate family member receiving hospice care?*
- Yes
- No
Have you experienced the loss of a loved one during the past year?*
- Yes
- No
If yes, what was your relationship to the deceased?
Do you have any allergies that would prevent you from providing in home care?*
- Yes
- No
If yes, please list allergies.
Number of miles willing to travel from your home to provide volunteer support, keeping in mind the agency provides mileage reimbursement.*
Military Service
Are you or were you a member of the U.S. Military? Please select your status here.*
- Active Duty
- Reserve
- Retired
- Discharged
- No Status
What was your branch of military service?*
- Army
- Navy
- Air Force
- Marines
- Coast Guard
- National Guard
Are you interested in serving as a volunteer in our Vet-to-Vet program?*
- Yes
- No
Employment Information
Are you retired?*
- Yes
- No
Are you currently employed?*
- Yes
- No
Current employer
Position
Phone
May we contact you at work?
- Yes
- No
Please describe your work experience.
Character & Professional References
Please provide 2 references.
Please provide 2 references.
Name Phone Email
Code of Ethics for Volunteers
As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professionals in the field in which I work. I, like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me. I understand that any information that is disclosed to me while assisting the Hospice is confidential. I interpret "volunteer" to mean that I have agreed to work without financial compensation. As a volunteer worker, I expect to do my work according to the standards set forth in Volunteer Policies and Procedures. I understand that my acceptance as a volunteer is contingent upon the successful completion of my references, criminal background/sex offender investigation and pre-volunteer drug screen. I understand volunteers must attend a volunteer workshop requiring 12 hours of education and that Accreditation Commission for Healthcare (ACHC) requires 12 hours of continuing education annually. I understand that I must also submit to a TB test prior to volunteering.
Full Legal Name*
Signature using full legal name
Date*
MM slash DD slash YYYY
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, I authorize inquiries to be made concerning my character and public records for the purpose of determining my suitability as a volunteer.
Full Legal Name*
Signature using full legal name
Date*
MM slash DD slash YYYY
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Name	Phone	Email

Volunteer Application

Volunteer Application

Emergency Contact Information

Volunteer Experience

Education & Speciality Training

Special Services & Complimentary Therapies

Areas of Interest, Availability and Skills

Military Service

Employment Information

Character & Professional References

Code of Ethics for Volunteers

Declaration