|
Hospice of Washington County, Inc.
747 Northern Ave, Hagerstown, MD 21742
301-791-6360 | Fax 301-791-6579
HWC complies with Title VI of the Civil Rights Act 1964, and the Rehabilitation Act 1973 and the Age Discrimination Act 1975.
APPLICATION FOR VOLUNTEER WORK
(please check desired class) Daytime (9:00 - 3:00) or Evening (6:30-9:30) - Last: First: Middle:
- Address:
- City: State: Zip Code:
- Employed by:
E-Mail Address:
- Telephone Number: Day - Evening -
- Availability
Upon completion of the training class, generally I will be available the following times:
Morning Afternoon Evening During the week Weekends
- I have a valid driver's license, car insurance and car.
- Life Experiences - Interest in Hospice:
Please explain briefly why you are interested in volunteering for Hospice of Washington County, Inc.
Describe any personal experiences in the areas of death and dying and year of occurrences.
Describe volunteer work you have done in the past or are doing currently.
- Completion of the following is optional:
Age: Date of Birth:
Ethnic background: Religious preference:
Marital Status:
Number of children Fluency in other languages:
- How did you hear about the Hospice of Washington County, Inc. Volunteer Training Program?
- Please list your hobbies/interests
a. b. c. d.
- Commitment
a. Are you willing to attend Patient Care Volunteer training for a total of 24 hours?
b. Will you be able to attend monthly continuing education/support meetings during daytime hours after becoming a HWC volunteer?
- Have you ever been convicted of a crime or received a verdict of anything other than not guilty in any criminal investigation or proceeding?
If yes, describe when the conviction occurred; the facts and circumstances, and any facts pertaining to rehabilitation. (Do not list any criminal charges for which the records have been expunged. A criminal offense will not necessarily bar employment).
|
