Get Involved with Hospice & Palliative Care of Iredell County

Volunteer Application

The definition of a volunteer: one who enters into or offers himself for a service of his own free will. Whether a Hospice & Palliative Care of Iredell County volunteer chooses to hold a pen or a hand, they give the most precious gift of all – time.

Donate

Help us continue serving our community with compassion, comfort and dignity.

Volunteer

Make a powerful impact on the lives of your neighbors in their time of greatest need.

Receive Updates

Receive the latest news about upcoming events, volunteer opportunities and more.

Personal Information

First Name*

Middle Name*

Last Name*

Address*

Address 2

City*

State*

Zip*

Home Phone*

Business Phone

Cell Phone

Email*

Desired Contact Method:*

Home
Business
Cell
Email

Education and Training

Elementary School

Name and Location of School*

Course of Study*

Years Completed*

Diploma/Degree*

Did You Graduate?*

Yes
No

High School

Name and Location of School*

Course of Study*

Years Completed*

Diploma/Degree*

Did You Graduate?*

Yes
No

College

Name and Location of School

Course of Study

Years Completed

Diploma/Degree

Did You Graduate?

Yes
No

Other

Name and Location of School

Course of Study

Years Completed

Diploma/Degree

Did You Other?

Yes
No

Employment History

Start with your present or most recent employer. Give accurate, complete information accounting for all periods of time including military service and any periods of unemployment. Please give month and year.

Company Name*

Phone Number

Employed From (month)*

(year)*

To (month)*

(year)*

Duties Performed:*

Company Name

Phone Number

Employed From (month)

(year)

To (month)

(year)

Duties Performed:

Company Name

Phone Number

Employed From (month)

(year)

To (month)

(year)

Duties Performed:

Volunteer History

Please list your volunteer service with any other organization/agency. (Please include church service if applicable).

Organization Name*

Phone Number

Employed From (month)*

(year)*

To (month)*

(year)*

Duties Performed:*

Organization Name

Phone Number

Employed From (month)

(year)

To (month)

(year)

Duties Performed:

Organization Name

Phone Number

Employed From (month)

(year)

To (month)

(year)

Duties Performed:

References

Give three references listing name, address, phone number, and occupation. Do not list relatives or former employers.

Name*

Phone*

Address*

Address 2

City*

State*

Zip*

Name*

Phone*

Address*

Address 2

City*

State*

Zip*

Name*

Phone*

Address*

Address 2

City*

State*

Zip*

Volunteer Interests

To assist us in securing a proper assignment for you, please check any of the following areas that interest you as a volunteer.

Office/Clerical
Direct Patient Care
Maintenance

Board of Directors
Organization Comittees
Special Projects

Public Speaking
Errands
Fundraising Events

Health Fairs
Bereavement Support
Memorial Service

Telephoning
Marketing
Other:

Have you recently (within last 12 months) experienced the death of a family member or close friend? *

Yes
No

If Yes, please specify.

Do you drive?*

Yes
No

Do you have a vehicle at your disposal?*

Yes
No

Do you have any of the following special skills or hobbies? Check all that apply.

Nursing
Public Speaking
Musician

Pet Therapy
Massage Therapy
Art Therapy

Cooking
Foreign Language
Computers

Hobbies
Other:

How much time do you feel you will be able to contribute to Hospice?

Hours*

per:*

Week
Month

Optional Information

Date of Birth

Marital Status

Spouse's Name

Ages of Children

Do you have any physical limitations that might affect your volunteering?

Emergency Contact

Name*

Relationship*

Phone*

Alternate Phone

HOIC does require criminal background checks on volunteers. Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, in the past seven (7) years that has not been annulled or expunged or sealed by a court?*

Yes
No

If Yes, please describe in full.

I certify that to the best of my knowledge, the information contained in this application is true and correct.*

Submit Application

STATESVILLE OFFICE

2347 Simonton Road

Statesville, NC 28625

Phone: 704-873-4719

Map & Directions

MOORESVILLE OFFICE

150 Fairview Road, Ste. 325

Mooresville, NC 28117

Phone: 704-663-0051

Map & Directions

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