Volunteer Application Thank you for your interest in becoming a Living Waters Hospice volunteer. Please complete the application below. Fields marked with an asterisk are required. Personal Information First Name * Middle Initial Last Name * Are you at least 18 years old? * YesNo Preferred Living Waters Hospice Location * Select a locationRiverside, CAGolden Valley, AZ Street Address * City * State * ZIP Code * Email Address * Cell Phone * Home Phone Alternate Phone Employment and Education Employer Work Phone Occupation Typical Working Hours Briefly describe the type of work you do Highest Level of Education Select an optionHigh SchoolTwo-Year CollegeFour-Year CollegePostgraduateOther Languages Spoken Volunteer Availability Approximately how many hours per week could you volunteer? * When are you generally available? * Weekday daytimeWeekday eveningsWeekendsFlexible or variesOther Please provide any additional details about your availability About You How did you hear about Living Waters Hospice? What inspired you to volunteer with Living Waters Hospice? What organizations, clubs, churches, or community groups are you involved with? Have you had experience with hospice, caregiving, serious illness, or people who are terminally ill? YesNo If yes, please briefly describe your experience Has someone close to you died within the past year? YesNo This question helps our volunteer coordinator determine the most appropriate timing and placement. A recent loss does not automatically prevent you from volunteering. Is there anything you would like us to know about that experience? Transportation and Background Do you have reliable transportation for volunteer work? * YesNo Do you have a valid driver's license? * YesNo Do you have automobile liability insurance? * YesNo Automobile liability insurance is required if you use your vehicle for hospice volunteer work. Have you been convicted of a felony within the past seven years? * YesNo A conviction does not automatically disqualify an applicant from volunteering. If yes, please provide any information you would like us to consider Experience and Skills Describe any experience, education, skills, hobbies, certifications, or previous volunteer work that may be helpful in a hospice setting Areas of Interest Direct Volunteer Opportunities Select all that interest you: Patient or family visitsMeal preparationShopping or errandsCaregiver reliefReading to patientsLight homemaking assistanceMusic supportWriting lettersChildcare supportBereavement follow-upMassage therapyPet therapyVigil volunteerHairdresser or barber services Indirect Volunteer Opportunities Select all that interest you: Office assistanceSewing or craftsComputer workSpeakers bureauVideo supportMusic or entertainmentMass mailingsPhotographyHosting hospice events Are there any other ways you would like to contribute? Personal References Please provide two personal or professional references who are not immediate family members. Reference One Name Relationship Phone Reference Two Name Relationship Phone Emergency Contact Emergency Contact Name Relationship Primary Phone Alternate Phone Physician Name Physician Phone Applicant Certification Type your full legal name as your electronic signature * I certify that the information provided in this application is accurate and complete to the best of my knowledge. I understand that submitting this application does not guarantee acceptance or placement as a Living Waters Hospice volunteer. I authorize Living Waters Hospice to contact me regarding this application and to contact the personal references listed above. Please do not submit Social Security numbers, driver's license numbers, insurance policy numbers, patient information, or medical records through this form.
