Volunteer Application

Volunteer Information

Name*

First, MI Last

Nickname

Date of Birth*

Home Phone*

Cell Phone

Work Phone

Address*

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

Email*

Emergency Contact Name*

First Last

Emergency Contact Relationship*

Emergency Contact Phone Number*

Employment, Education, and Volunteer Experience

Employer Name (current or previous)*

Occupation/Title*

Are you currently employed?*

Full Time
Part Time
Retired
N/A

High School*

Check last grade completed.

College*

Check number of years completed.

College Major

Have you previously served as a volunteer?*

Yes
No

If yes, where?*

What type of service?*

Interests and Availability

Please select the location where you would like to volunteer.*

Newark area (New Castle County)
Dover area (Kent County)
Milford area (Sussex County)
Pennsylvania
Delaware Hospice Center in Milford

Please select interests/preferences.*

Please select all that apply.

Please select the days you are most often available to volunteer.*

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Please select the times you are most often available to volunteer on Sundays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Mondays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Tuesdays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer Wednesdays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Thursdays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Fridays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Saturdays.*

Please select all that apply.

Morning
Afternoon
Evening

Skills and Experience

Clerical Skills

Typing
Filing
Computer Skills
Medical Records
Mailings
Data Entry
Using Copier

Communication Skills

Public Speaking
Journalism
Photography
Graphic Art
Calligraphy
Public Relations

Please list any foreign language(s) that you speak.

Please list any skills/hobbies that you use or teach.

(such as baking, sports, hair styling/cutting, crafts, musical instruments, etc.)

Military Experience

Reason for volunteering with Delaware Hospice*

How did you hear about volunteer opportunities with Delaware Hospice?*

Personal Reference

Personal Reference Name*

First Last

Address

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

Phone*

Relationship*

Photographic/Testimonial Release

By becoming a Delaware Hospice Volunteer, I hereby assign all rights to the film/ photography/ videotape/ sound recordings/ testimonials made of or by me for Delaware Hospice, and I hereby authorize the use of same by Delaware Hospice, and those acting with its permission, for the purpose of illustration, publications, or broadcast in connection with the work of Delaware Hospice. I expect no financial remuneration for lending my image or testimonial to the marketing, public relations, or advertising efforts of Delaware Hospice.

Photographic/Testimonial Release

Untitled

Thank you for your interest in volunteering with Delaware Hospice!

Volunteer Information

Employment, Education, and Volunteer Experience

Interests and Availability

Skills and Experience

Personal Reference

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