Hospice Volunteer Form | Hospice of CNY & the Finger Lakes

Volunteer Application Form

Hospice of Central New York & Hospice of The Finger Lakes does not discriminate on the basis of race, ethnicity, color, sexual orientation, gender identity or religion.

Thank you for your interest in becoming a Hospice of CNY & Hospice of The Finger Lakes volunteer. This application form was developed specifically for the Hospice program and is confidential. The information will help us to find the kind of work assignment you will most enjoy.

Phone

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Today's Date

FAX

Phone(Required)

Email(Required)

Occupation(Required)

Employer(Required)

Business Phone

Education/Schools Attended(Required)

Degree

Major

How did you learn about Hospice volunteer opportunities?

Employment History

Dates of Employment From

Dates of Employment To

Description of Work

Professional Affiliations/Honors

Volunteer Experience(Required)

Volunteer Experience Date From

Volunteer Experience Date To

Tell us about yourself. Experience, special skills, office skills, arts and crafts, music, etc(Required)

Foreign languages(Required)

Are you a Veteran?(Required)

Have you ever been convicted of a crime or violation other than minor traffic infractions? (Conviction would not necessarily result in the denial of role of Family Care Giver) If yes - please explain(Required)

Has someone close to you died recently? If yes, please explain the impact on you(Required)

Emergency Contact Information(Required)

First Last

Phone(Required)

Relationship to You(Required)

Any other remarks?

As a volunteer, I realize that I am subject to a code of ethics similar to that which binds paid employees of Hospice of CNY & Hospice of the Finger Lakes. I, like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me.

I interpret "volunteer" to mean that I have agreed to work without compensation in money but having been accepted as a volunteer worker, I expect to do my work according to standards set forth in the Volunteer Policies and Procedures Manual.

By my signature, I declare that the above information is true and correct as contained in this application.

Volunteer's Signature(Required)

Date of Signature(Required)

For Office Use Only - Staff Signature/Date Required Following Review

Staff Signature (For office use only)

Date of Staff Signature (For office use only)

Hospice of Central New York & Hospice of The Finger Lakes complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 315-634-1100

Hospice of Central New York & Hospice of The Finger Lakes cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-315-634-1100.

Hospice of Central New York & Hospice of The Finger Lakes me.

Become a Volunteer

Volunteer Application Form

For Office Use Only - Staff Signature/Date Required Following Review