Exceptional Care

Every Day

CarePartners Hospice
Volunteer Application

CarePartners Hospice Volunteer Application
Status

Contact Information

Section

Section

Section

What kinds of email would you like to receive?

Availability

Please give your specific availability on each day (Sunday through Saturday) specific to the half hour.
My availability is *
Please enter the date when your availability begins.
Please enter the date when your availability ends.
Please enter the number of hours you are willing to serve.
Frequency *
Please select the frequency of the number of hours just entered.

Experience & Interests

Please list previous jobs and volunteer roles. Indicate if each role was as a paid employee or a volunteer.
Have you ever been employed by/volunteered with CarePartners or a Mission Health system affiliate? If yes, list position and dates.
Have you ever been dismissed or forced to resign from any job or volunteer position? If yes, please explain.
Are you currently enrolled at a college or university? If yes, list school and course of study.
Skills and Interests *
Preferences *

References

Please use references who have known you at least one (1) year. Do NOT list physicians, relatives or anyone living with you. Provide complete mailing address, email addresses are preferred.

Reference 1

Reference 2

Reference 3

Vaccination Requirements

All Mission Team Members, including volunteers, must comply with Mission Health's vaccination policies. A vaccination screening appointment with Mission WorkWell will be scheduled as part of the intake process. Please be ready to produce any available immunization records.

Current policy requires:

  1. Varicella (chicken pox) vaccine or proof of immunity
  2. Tetanus, Diphtheria & Pertussis (tdap) vaccine
  3. Measles, Mumps & Rubella (MMR) vaccine or proof of immunity (those born before January 1, 1957 are exempt from MMR vaccine)
  4. Influenza vaccine for the current flu season
  5. Tuberculosis screening

Volunteer Agreement

I hereby certify that the answers on this application and any resultant interviews are true and correct, and that any misrepresentation or omission of facts, misleading or false information on my part will be grounds for dismissal as a volunteer.

Acceptance as a volunteer is contingent upon satisfactory references, verification of the information submitted on this application, compliance with vaccination requirements and a criminal record check. I, therefore, authorize you make such investigations and inquiries you deem necessary in arriving at a decision.

I acknowledge and agree that I am not obligated, if called upon, to perform the volunteer services herein applied for, and CarePartners Hospice Volunteer Team is not obligated to assign or actively seek to assign volunteer services for me.

I authorize that all employers, schools, or references thus contacted be released from all liability in answering questions related to my application.

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