Volunteer Application Please enable JavaScript in your browser to complete this form.Name *FirstLastStreet AddressCity, State & Zip CodePhone (h)Phone (c)Phone (w)Email *Current EmployerMay we call you at work?YesNoVolunteer ActivitiesPlease list the organization, your responsibilities and the dates of your involvement.Do you have any hobbies, knowledge, experience or professional skills that you feel can be incorporated into your hospice work? Please explainWhat has currently brought you to Hospicare to want to volunteer?Describe any limitations that would be helpful to know when assigning you to volunteer (i.e. bad back, hearing problems, allergies, emotional triggers, etc.)What experiences have you had in your own life with death or other types of loss?Has there been any significant losses in your life in the last year? (if yes, please explain)Have you ever provided care to anyone who was dying? If yes, please explain:Hospicare asks for 2 –4 hours a week of volunteer time; are you able to commit to this for one year after the training?When are you available to do your work as a volunteer?MorningsAfternoonsEveningsWeekendsWhere do you see yourself carrying out your volunteer work? (Please check all that apply):The Hospicare Center in Ithaca doing a mealtime shiftWorking with families in their homes providing companionship and/or respite careNursing home visits to hospice patientsAdministrative /Clerical assistance in the Ithaca officeHelping out with special eventsGardening at the Hospicare Center in IthacaProviding massage to patientsWeekly, or bi-weekly grocery shopping for the Hospicare Center in IthacaMake bereavement phone callsAssist in the bereavement program (office tasks, events, transportation facilitate social groups)If you'd like to work with families or provide massage, what country do you see yourself carrying out your volunteer work?Tompkins CountyCortland CountyPlease list three references that we can contact to ask some general questions about you; making sure at least one is professional in nature. Please include full name, relationship to you (work or personal), phone number(s) and email address. By checking this box and typing my name below, I am electronically signing this form and giving my consent for the release of information regarding me from the references listed above.. * *YesElectronic Signature *Submit