Work Experience

Work Experience 1

Job Title / Work Schedule 1

Date (From)

Date (To)

May we contact the organization as a reference?

Yes
No

Work Experience 2

Job Title / Work Schedule 2

Date (From)

Date (To)

May we contact the organization as a reference?

Yes
No

Volunteer Experience

Organization

Date (From)

Date (To)

Duties performed

May we contact this organization as a reference?

Yes
No

References

No family members

Reference 1 Name*

First Last

Reference 1 Address*

Street Address City State ZIP Code

Reference 1 Phone*

How do you know Reference 1?*

Reference 2 Name*

First Last

Reference 2 Address*

Street Address City State ZIP Code

Reference 2 Phone*

How do you know Reference 2?*

We guarantee confidentiality to all Hospice patients and families. Will you honor that guarantee?*

Yes
No

We are required to run background checks on volunteers and employees, which requires applicants to share their Social Security number with us. Direct patient contact is contingent on the receipt of an approved background check.

By signing this application, I hereby verify the above information to be accurate, and give Hospice of the Red River Valley permission to contact my references, unless noted otherwise in the Work or Volunteer Experience sections. Your initials below will serve as your signature.

Initials*

Date*

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Apply to the Volunteer Program

Step 1 of 3

What type of volunteer work would you like to do?

Work Experience

Volunteer Experience

References

Finding Comfort in Care: The Schilling Family’s Journey with Hospice

A Love Story of Strength and Support: Lloyd and Linda’s Journey with Hospice Care

Grief Support for Adults – Support Group – East Grand Forks

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