Have you been convicted of a felony within the last 7 years? Answer no for 1st conviction of drunkenness, minor traffic violation, disturbance of peace, or simple assault.
Do you currently or have you previously worked for the VNA of Cape Cod, Inc.?
How will volunteering affect your work responsibilities?
Why are you considering becoming a hospice volunteer? Include what you expect to gain from the experience and what you might find most difficult.
Have you ever spent time with someone very sick or dying?
Would you like to share anything else about your interest in hospice volunteering?
A patient or client’s name, clinical, records, other information about their health, social, financial circumstances, and about what takes place in the home shall be kept confidential and shall be released only as required by law or authorized by the patient or client.
My services are donated to the VNA without contemplation of future employment and given for humanitarian, religious or charitable reasons.
I may resign from the volunteer program after notice to my immediate supervisor and the volunteer coordinator.
I shall not sell or attempt to sell personal goods or services, request contributions or solicit persons to sign or distribute political petitions on VNA premises or in patient or client’s homes.
I shall be punctual and conscientious, conduct myself with dignity, courtesy and consideration of others, and endeavor to make my volunteer activities professional in quality.
I shall attempt to resolve any problems related to my volunteer activities with my supervisor, and, if unsuccessful, attempt to resolve such problems with the volunteer coordinator.
I shall at all times uphold the philosophy and relevant policies of the VNA.
I grant the VNA of Cape Cod, Inc. permission to take and use written material, videos and/or photos in which I am included, for publicity purposes. I acknowledge I will receive no compensation for any publicity that may arise from the use of any afore mentioned materials, If I do not wish to be photographed or interviewed, I understand it is my responsibility to notify the volunteer coordinator and/or the operators of any production equipment of my objection.
3. Three or more absences without prior notification.
5. Any other circumstances which, in the judgment of the VNA would make continued volunteer service contrary to the best interests of the VNA.
I have read each of the above conditions and I agree to be bound by them and that all information on this application is true and complete to the best of my knowledge.