Expression of Interest for Volunteering
The information on this form is strictly confidential. It is meant to give Hospice the opportunity to get to know you a little better and understand how you would like to contribute.
Date: Click here to enter a date.
Name: (please print) Click here to enter text.
Address: Click here to enter text. Postal Code: Click here to enter text.
Phone #s: home: Click here to enter text. Work: (if appropriate)Click here to enter text.
e-mail: Click here to enter text. Languages spoken besides English: Click here to enter text.
Please check the following that applies: Employed? Choose an item.
A minimum of 3 volunteer hours per week for the period of one year is expected. Can you make this time commitment? Choose an item.
Please briefly describe your current or past work and/or volunteer experience over the last five years.
Click here to enter text.
What are your interests and hobbies?
Click here to enter text.
We have a variety of volunteer positions at Hospice. Check off any activities that interest you as a volunteer.
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☐ House reception, greeting guests, receiving
incoming calls
☐ General office duties including mail-outs,
phoning, processing mail
☐ Grounds maintenance, garden and area
☐ Building maintenance, support in house
☐ Fundraising
☐ Meal assistant, includes serving meals to the
residents, baking and kitchen support
☐ Visiting clients in the community
☐ Music program, piano, singing, harp etc.
☐ Complimentary Care, Reflexology, Gentle
Touch, Massage
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Have you experienced a personal bereavement during the past two years? Choose an item.
Please write a statement about how you first became interested in Hospice and why you wish to become involved as a volunteer. Describe how you hope to benefit and grow personally from this experience.
Click here to enter text.
Do you have any health limitations which would prevent you from doing certain types of volunteer work? If so, Please describe:
Click here to enter text.
Please provide two personal references (Contact will be made only after the introduction session prior to training)
Name: (please print) Click here to enter text.
Address: Click here to enter text. Postal Code: Click here to enter text.
Phone #s: home: Click here to enter text. Work: (if appropriate)Click here to enter text.
e-mail: Click here to enter text. (preferred method of contact, please include)
Name: (please print) Click here to enter text.
Address: Click here to enter text. Postal Code: Click here to enter text.
Phone #s: home: Click here to enter text. Work: (if appropriate)Click here to enter text.
e-mail: Click here to enter text. (preferred method of contact, please include)
How did you hear about volunteering opportunity? (please check one or more)
☐Word of mouth ☐Newspaper ☐Radio ☐Community Presentations
☐ Friend ☐Facebook ☐Twitter ☐Personal hospice experience
☐Other, Please specify: Click here to enter text.
Thank you for completing this application form. This form is the first step in expressing your interest in volunteering at Hospice. This information is held until the next Volunteer training session begins, trainings are held in the spring or fall each year. We will contact you with an invitation to participate in the next introduction session. After the introduction session you can decide if you wish to participate in the Hospice Volunteer Training sessions. We highly value and respect our volunteers and select those most suited to working with a vulnerable population. This work could not be done without our volunteers.
Your signature below gives the North Okanagan Hospice Society permission to contact your references.
Please return your application by mail or in person to the Support Service Leader, Tanya Stilborn.
Signature______
G:\Volunteers\CSSM\Application and Info\Volunteer Application - June 2010.doc