Volunteer Application Form - Sharon S. Richardson Community Hospice

Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Email*

Current Employer*

How did you learn about volunteering at Sharon S. Richardson Community Hospice?*

Do you speak a foreign language?*

If yes, what language(s)?

Do you know sign language?*

Are you a veteran?*

Do you have any computer skills?*

Have you experienced the loss of a loved one in the last 12 months?*

If yes, what was the relationship?

Did you have a friend/relative who is/was a hospice patient?*

Have you ever been a caregiver for someone who has died?*

Previous Volunteer Experiences (start with most current):*

Special Skills/Hobbies:*

Volunteer Positions: Patient Care, Support Services & Resale Store

Resale Store Volunteer Positions (Please select all that apply):*

Cashier
Customer Service
Merchandising
Donations

Patient Care Volunteer Positions (Please select all that apply):*

Support Services Volunteer Positions (Please select all that apply):*

Please provide 3 personal references. References may not be related to you.

Reference #1: Name, Phone Number, Email & Relationship*

Reference #2: Name, Phone Number, Email & Relationship*

Reference #3: Name, Phone Number, Email & Relationship

SSRCH is mandated by law to perform caregiver background checks. Every applicant will be required to pass a background check and attend orientation prior to becoming a volunteer.