Volunteer Application

May we contact you at your place of employment?

 Yes No N/A

What is the best time to reach you by telephone?

 Morning Day Evening

Summary of Employment History: [You may also attach a resume]

Accepted files: .pdf, .doc, .docx, .jpg Size Limit: 4mb

Tell us about further training and/or accreditations to your credit:

Current and/or previous Volunteer Experiences:

In which areas are you most interested in Volunteering with Pilgrims Hospice Society?

What days and times are you typically available to Volunteer? [Please select all that may apply - Hold Ctrl/Command to select more than one time period in any given day]







Why have you chosen to apply to Volunteer with Pilgrims Hospice Society?

What personal qualities and interests will you bring as a Volunteer to the Hospice?

Do you have any physical or medical restrictions/ conditions that may affect your function as a Volunteer? [ie: allergies, back, poor vision or hearing, mobility, etc.]

 No Yes [if yes, please describe]

What do you hope to gain from the experience of being a Volunteer with Pilgrims Hospice?

Would you like to use your volunteer experience to fulfill requirements for student field placement? If so, please provide us with the name of the educational institution and program. Please note that your educational institution will be contacted in order to determine whether Pilgrims Hospice Society meets supervisory standards.

Do you know a language other than English?

 Yes No

 Speak Read Write

 Speak Read Write

How did you learn of Pilgrims Hospice Society Volunteer Services?

or Other

Please provide two professional references whom we may contact:
 Business Personal

 Business Personal

Please read the following and submit your application below

I understand that the information provided in this application to volunteer with Pilgrims Hospice Society is part of the Volunteer permanent file at Pilgrims Hospice Society. This information will be kept confidential and only be used to assist Pilgrims Hospice Society in completing its volunteer screening process and in making the best possible match between me and a patient and/or assignment within the Hospice.

I also understand that if I am accepted as a volunteer with Pilgrims Hospice Society, I am committing to attending Volunteer education and training sessions provided by the Hospice and to abiding by the Policies and Standards of Practice of Pilgrims Hospice Society.

I hereby certify that all information included in this application form is true and complete. I give permission to an authorized Society representative to conduct reference checks with the above named referees and release Pilgrims Hospice Society and all others from liability in connection with same.

I have read and agree to the terms above:  Agree Disagree