First Name (required) Last Name (required)
Middle Name (required) Street Address (required)
City (required) State (required)
Zip Code (required) Birthday (mm/dd/yy) (required)
Are you a Veteran? If yes, which service branch? Personal Email
Work Email Which email do you prefer that we use to contact you? HomeWork
Cell Phone Home Phone
Work Phone Which phone do you prefer that we use to contact you? CellHomeWork
Education History
Employment History - Most Recent
What, if any certifications/licenses do you currently hold? Are you fluent in any language other than English? If yes, which one(s)?
What interests or skills would you like to utilize as a volunteer? Check all that apply BakingCleaningCookingCreative WritingData EntryEvent PlanningFundraising or Grants ResearchGardeningGraphic ArtsGroundsworkHealth careMaintenance - RepairsMarketing - Social MediaMusicNursingPhotographyPublic SpeakingSewingTechnical Computer Support
Other skills you'd like to share with Quiet Oaks
Describe your previous volunteer experience, including any as a hospice volunteer? Please include where and when
How did you learn about Quiet Oaks Hospice House? Another QO VolunteerFamily or friend was served by QOChurchRadio or NewspaperFacebook or other Social MediaVolunteer or job fairOther
Briefly share your reason for wanting to volunteer at Quiet Oaks Hospice House.
These are primary volunteer areas at QO. Check all area(s) that interest you? If none apply, tell us more in 'Other skills you'd like to share with QO" above. Kitchen: meal prep, cooking, baking, serving, cleanupResident companion or care: assist nursing staff with companion care and daily tasksHouse support: indoor cleaning, decorating, plants and floral, painting, maintenance.Groundskeeping: outdoor gardening, painting, mowing, shoveling, maintenanceEvents: helping with advance planning or day of eventsMusic: vocals, instruments, groupOffice support: administrative, data entry, filing, copying, organizing
How often do you wish to volunteer? DailyWeeklyTwice a monthMonthlyEvents only What is your general availability to volunteer? MorningsAfternoonsEveningsWeekdaysWeekendsWhenever you need me
Any other comments about your availability to volunteer?
Emergency contact First and Last Name Emergency contact phone number Emergency Contact Relationship Do you have any health problems or physical disabilities you feel should be considered before you are placed as a volunteer?
The above information is true and I verify that I am the person listed above on this application. We require that each applicant complete their own form. If you are entering an application for another person, please email us at vcoord@quietoakshospicehouse.org for an explanation after submitting this form. By submitting this form, you represent that the above statements are true and authorize Quiet Oaks to verify the information you have provided. You understand that Quiet Oaks requires a thorough background investigation for all potential volunteers. This investigation is conducted following Volunteer Orientation and includes but not limited to a criminal background check. You will be asked to provide documentation such as drivers license and social security number in addition to what has been provided on this application when you attend Volunteer Orientation.
I agreeI am filling this out for someone else
