Volunteer Application

Thank you for your interest in becoming a Hospice volunteer. Please fill out the form below
to apply for a volunteer position with us. Qualified applicants receive equal consideration.
No question is asked for the purpose of excluding any applicant due to race, creed, color,
national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation,
or any other characteristic protected by law. You will be contacted by our Volunteer department
to schedule an interview and discuss the training program. Please call us with any questions
you may have.

If you do not wish to apply online, you can find a PDF application here.
The field descriptions in PURPLE text are required.
First Name: Last Name: M.I.
Address:
City: State: Zip:
Home Phone: Cell Phone:
E-mail:
Employer: Occupation: Working Hours:
Briefly describe the type of work you do:
Days Evenings Weekends
Are you under 18 years of age?
Birthday:

Experience & Education
Level of Education:
List experiences you believe would be helpful to you in hospice volunteering,
i.e. schooling, work, volunteer experience, office skills, arts and crafts, etc.

Personal Information
How did you hear about LightBridge?
Why do you wish to be involved with Hospice?
Have you had experience with the terminally ill?
If yes, please explain:



Has someone close to your died within the past year?
If yes, please explain:
I prefer not to work with the following types of patients:
Do you speak any foreign language?
If yes, what languages?
Have you been convicted of a
felony within the last seven(7) years?
(A conviction will not necessarily disqualify
you from volunteering.)
Please describe any volunteer work you've participated in:
What do you like about yourself?

Religious Affiliation:
(This section is optional. It assists us in proper placement of our
volunteers. We serve patients regardless of religious affiliation.)
Do you have available transportation
for your volunteer work?
Do you possess a valid driver's license?
It is the policy of LightBridge Hospice to check employee's and volunteer’s Department of Motor Vehicle's driving record upon hire and on an annual basis. An individual will not be eligible for hire, volunteer activities, or continued employment if they:
• Have had more than three (3) moving violations or more than one chargeable accident in the past thirty-six (36) months.
• Have had a major conviction (driving under the influence of alcohol or drugs) within the past seven (7) years.

Areas of Interest

Please choose areas of interest.
(To select more than one item, Cmd-click for mac and Ctrl-click for pc.)
Direct:
 Indirect:

Personal References
First Name: Last Name:
Address:
Years Known: Telephone:
First Name: Last Name:
Address:
Years Known: Telephone:

Emergency Contact
Name: Telephone:
Physician: Telephone:
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