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Suite Living Volunteer Application

Do You Have A Valid (State) Driver's License?
Have You Ever Been Convicted For Violation Of Any Laws, Traffic Or Otherwise?
Do You Have Any Physical Condition that May Limit Your Activities?

Employment

Skills & Experience

Availability and Volunteer Assignment Preferences Please Check All That Are Applicable: I Am Available

References

Photo Release

Please read the following carefully before signing this application:

I understand that Suite Living Hospice Care requires certain information about me to evaluate my qualifications for their volunteer program. Therefore I authorize the Suite Living Hospice to contact the above listed references. I agree to release those parties supplying such information to the Company from all liability or responsibility with respect to the information supplied. I also understand that the Company will complete a consumer report (background check or driving records check) if required by the state guidelines or due to my volunteer tasks. In the event that information from the report is utilized in whole or part in making an adverse decision with regard to my potential volunteer opportunity with us, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the Federal Fair Credit Reporting Act. The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be given a summary of these rights together with this document.

 

I agree that I will not disclose or use while volunteering any confidential or proprietary information of others.

 

I will respect the rights of the patients while in their home.

 

I understand that as a volunteer I am not to accept any gifts from any of the patients or their family members.

 

I understand that any false answers or statements made by me on this application may be grounds for refusal of my offer of volunteer services.

 

My signature below acknowledges that I have read and understand the entire application.

REQUIRED IF UNDER 18 YEARS OF AGE:

I certify that                                               , my son/daughter, is fully capable of participating as a volunteer without compensation and has my permission to be assigned and participate as a volunteer for Suite Living Hospice.

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