Volunteer Application

Apply to Volunteer Today

To apply for one of our open positions, please click here: Coastal Hospice Careers

Thank you for your interest in volunteering with Coastal Hospice. The following information helps provide us with a clear understanding of your skills and interests, and will help us when making volunteer assignments. Coastal does not discriminate in volunteer recruitment, training, or assignment practices based on race, color, creed, gender, national origin, disability, marital status, sexual orientation, or age.

Coastal - Volunteer Application Form

Location to Apply to:

First Name

Last Name

Birthdate

Cell Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Volunteer Information:

Please note that your volunteer eligibility and authorization to work in the U.S. will be verified.

Describe any past volunteer history and/or licenses/certificates you hold:

What draws you to volunteer with hospice?

Criminal Background Inquiry:

Have you ever been convicted of a crime, other than a minor traffic offense, or pled no contest to a crime?

Yes

If yes, please explain.

Emergency Contact:

Emergency Contact Name & Relationship to You

Emergency Contact Cell Phone

Emergency Contact Work Phone

Emergency Contact Full Address

“I certify that the facts contained in this application are true and complete and to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information they may have, personal or otherwise, and release all parties from all liability for damage that may result from furnishing same to you.”

Coastal Hospice is an EOE and provides services without regard to race, color, national origin, sex, religion, age and disability.

By checking this box, I consent to receive customer care notifications SMS messages from Coastal Hospice. Reply STOP to any message to opt-out; Reply HELP for support or call us at 1-888-788-5893; Message and Data rates apply; Messaging frequency may vary. For more information on how we protect your privacy, visit our Privacy Policy and SMS Terms & Conditions.

Signature

Date