Volunteer Application

ʻAʻa palapala noi

VOLUNTEER APPLICATION FORM

Thank you for your interest in Kauaʻi Hospice. We would like to learn more about you and how you would like to contribute to Kauaʻi Hospice and the families we serve, as well as what our staff can do to support you and your service. All information is kept strictly confidential. Upon receipt of your completed application a Kaua`i Hospice representative will contact you to schedule the next steps in your journey to serving as a Kaua`i Hospice volunteer. Thank you for helping us to get to know you.

Volunteer Application

Phone Number:
Person to notify in case of emergency:
Phone Number:
Are you currently employed?
May we call you at work?
Are you a Veteran?
Have you had experience serving as a volunteer?
Are you currently serving as a volunteer with any other organization, club, etc?
Are you willing to provide transportation for patients/ families if needed?
Do you have a valid Hawaii Driver’s License?
Do you have current Auto Insurance with minimum automobile liability coverage in compliance with Hawaii State Law?
Have you had a life experience, education or special training in which you feel would be helpful to you in your work?
Has someone close to you died?
In the last year, have you experienced a major life change (work situation, relationship, made a major move)?
Check all areas that you would be interested in helping with:
Check any special skills/interests you might be willing to contribute to Hospice:
Foreign languages
List three references (one professional, two personal), other than immediate family, who know you well:
Phone Number
Phone Number
Phone Number
Date:
This field is for validation purposes and should be left unchanged.

ʻAʻohe hana nui ke alu ʻia.

No task is too big when done together by all. If everyone contributes to the task, it lightens the load.