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Home > Volunteer > Volunteer Application

Volunteer Application

Hospice of the Northwest, an LLC of Skagit Regional Health and Public Hospital District 304 provides equal opportunity in employment, health care services and all related programs without regard to race, sex, creed, age, religion, color, national origin, disability or any other basis prohibited by law. Applicants may request a reasonable accommodation. Contact Human Resources at Skagit Regional Health with questions or complaints alleging violations of the Skagit Regional Health equal opportunity policy or to make a request for an accommodation.

Hospice of the Northwest serves Island, San Juan, Skagit, and North Snohomish counties. If you live outside this service area, please visit medicare.gov/care-compare/ to find a hospice near you.

Name(Required)

First Last

I like to be called(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Home Phone(Required)

Preferred Email(Required)

Enter Email Confirm Email

NOTE! Hospice Volunteers must have email & the ability to print Microsoft Word or PDF Documents.

Last four digits of your SSN(Required)

This is used to create your unique volunteer ID#.

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Emergency Contact Relationship(Required)

What is your relationship to your emergency contact?

Emergency Contact Phone(Required)

How did you hear about the Hospice Volunteer Program?(Required)

Type(s) of Volunteer Work Desired:(Required)

Patient/Family Care

Tuck In Program

Office/Administration

Vigil Team

Music and Memory

Hospice Library

Pet Peace of Mind Volunteer

Veterans Inclusion Volunteer

Other Administrative Volunteer

Check all that apply.

Are you able to lift 50lbs easily?(Required)

Yes

Do you have your own vehicle?(Required)

Yes

What is your current status?

Student

Employed

Retired

Other

Have you served in the military?(Required)

Yes

This field is hidden when viewing the form

Which branch?

Tell us about your Education, Employment and Volunteer Work that relates to this position(Required)

References

Please list 3 references not related to you by blood or marriage. Applications cannot be processed without this information.

Reference #1 Name(Required)

First Last

Reference #1 Phone(Required)

Reference #1 Email(Required)

Reference #2 Name(Required)

First Last

Reference #2 Phone(Required)

Reference #2 Email(Required)

Reference #3 Name(Required)

First Last

Reference #3 Phone(Required)

Reference #3 Email(Required)

Experiences

Please share your experiences with/perspective on death and dying(Required)

What, if any, losses have you experienced in the past year (death, divorce, health problems, etc.)? How has this affected you?(Required)

Please upload a copy of your driver's license and auto insurance.(Required)

Drop files here or

Max. file size: 150 MB.

As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professional in the field in which I work. I, like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me.

I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that, by submitting this application I authorize inquiries to be made concerning my employment, character and public records for the purpose of determining my suitability as a volunteer. I affirm that I have read the volunteer Code of Ethics above and agree to abide by its regulations. I agree to respect the confidentiality of any client information I acquire in the course of my volunteer activities with Hospice of the Northwest.

Applicant Signature(Required)

Date(Required)

MM slash DD slash YYYY

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227 Freeway Dr, Suite A
Mount Vernon, WA 98273

Phone: (360) 814-5550
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