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About Hospice Providers of the Desert
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Careers At HospicePD
Become a Volunteer at
Hospice Providers of the Desert
Name
Street Address
City, State
Email
Phone No.
Can you receive calls at work?
---
Yes
No
Current Place of Employment & Position
Date of Birth
Emergency Contact
Relationship
Emergency Contact Phone
Emergency Contact Address
How did you find out about Hospice Volunteering?
Choose one below...
Utilized services in the past
Newspaper/TV/Radio ad
Social Media
Website
Word of Mouth
School/Organization Volunteers
Friends and Relatives
School
School Contact
School Contact Phone
Parent/Guardian
Parent/Guardian Phone
Military Experience: Branch
Dates of military service
Interest and/or Certification
Choose one below...
Computer
Home Repairs
Notary
Sewing
Cooking/Baking
House Cleaning
Reading
Yardwork
Hairstylist
Musician
Registered Nurse
Videography/Audio
Are you fluent in a foreign language or American Sign Language?
Other: Please Explain
Time Availability
Weekday Mornings (7am-12pm)
Weekday Afternoons (12pm-5pm)
Weekday Evenings (5pm-9pm)
Weekday Overnight (9pm-7am)
Weekend Mornings (7am-12pm)
Weekend Afternoons (12pm-5pm)
Weekend Evenings (5pm-9pm)
Weekend Overnight (9pm-7am)
Desired Areas of Volunteering
Special Events
Administrative
Patient Support/Direct Care
Administrative Services (M-F daytime positions)
Phone receptionist
Greeting campus visitors
Cafe
Baking
Filing
Nurses' station receptionist
Mailings
Gardening
Direct Care/Patient Support
Visit patients in their homes (hospice & pre-hospice)
Visit patients in the inpatient unit
Visit patients in a facility (nursing home/ assisted living /hospital/group home)
Visit bereaved families
Hairdresser (copy of current license required if providing services to patients)
Pet therapy
Phone support
Delivering birthday cakes to patients
Patient/caregiver transportation
Evening & weekend refreshment cart
Special Events
---
Yes
No
Have you experienced the loss of a loved one in the past year? If so, please briefly describe:
Have you been convicted of a crime?
---
Yes
No
If yes, please explain:
Two references are required of Hospice Providers of the Desert volunteers. Please note, references should be professional in nature. Members of your family will not be considered as references regardless of any professional relationship with them. References from work or volunteer assignments are most helpful. Please use full names & provide complete addresses.
Name (1st reference)
Street Address
City/State
Zip Code
Email Address
Phone
Position/Relationship to you
Name (2nd reference)
Street Address
City/State
Zip Code
Email Address
Phone
Position/Relationship to you
I hereby authorize Hospice Providers of the Desert to request of the above individuals' information regarding my appropriateness as a Hospice Care Volunteer
I grant full permission to Hospice Providers of the Desert to use photographs of me for print and/or digital promotional purposes.
Submit
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