Comprehensive Community Hospice of Parker Jewish Institute: Volunteer Application

About the Hospice Program

Volunteering at Parker's Hospice program is a deeply rewarding experience. Our Hospice volunteers provide extra level of care and comfort to patients and their families in the last weeks and months of life.

All of our volunteers receive extensive training in providing comfort and support to families facing end-of-life issues. Topics covered during volunteer training include ways to communicate, active listening, identifying and respecting cultural differences, spirituality, and grief.

Required Time Commitment

All volunteers are required to commit to a minimum of a 6-month placement. If you are not available to volunteer consistently (including summer months if applicable) for the next six months, we ask that you hold your application until you are available to fulfill this commitment.

If you have any questions, please contact us at:

271-11 76th Avenue
New Hyde Park, New York 11040
Telephone: 718.289.2102; email: volunteer@parkerinstitute.org
Website: http:///parkerinstitute.org

Contact Information

Question Title

* 1. Applicant Information

First and Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Telephone Number

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* 2. Emergency Contact

First and Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Relationship to Applicant

Email Address

Telephone Number

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* 3. What is your age, please? (in years)

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* 4. What is your gender?

Male

Female

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* 5. What is your ethnic background/race? Please check all that apply (Optional)

White

Hispanic or Latino (please specify)

American Indian or Alaska Native

Multiracial (please specify)

African American or Black

Asian (please specify)

Pacific Islander or Native Hawaiian

Other (please specify)

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* 6. Do you know or have you studied any language(s) other than English?

Yes

If yes, please specify what language(s).

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* 7. How did you hear about this program? (Please check all that apply)

Family

Mail (i.e., newsletter, bulletin)

Friend/Colleague

Radio/Television

Flyer/Poster

Newspaper

Email/Web

Current or former volunteer

Other (please specify)

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* 8. Please describe your work experience?

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* 9. Please describe your past volunteer experience(s)?

Special Skills and Experience

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* 10. Please describe any specials interests, hobbies, skills, training, and awards?

Volunteer Availability and Interests

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* 11. What types of activities are you interested in doing as a volunteer?

Hospice Doulas
As part of a team, provide a cocoon of support to help ensure that no patient dies alone by being with the patient and their loved ones during the last few weeks and days of life.

Bereavement Volunteers
Visit grieving families and friends, make phone calls, help with bereavement support groups, and send bereavement letters.

Friendly Visitors
Visit patients and families at home, nursing homes, assisted living facilities. Pay a friendly visit; relieve a family caregiver for a short break; accompany a patient on a walk, an errand or a social event; read to a patient; listen to music together.

Administrative Volunteers
Provide support in the office: special projects, preparing mailings, answering the phones.

Telephone Assurance Volunteers
Make supportive phone calls to patients and their families weekly.

Student Interns
Meet educational requirements for field work while providing care to patients and families. Examples: social work, counseling, chaplaincy, nursing, nursing assistants, physician assistants, massage therapy, and art therapy.

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* 12. What date you are available to begin service?

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* 13. What days and times are you available to volunteer?

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* 14. What neighborhoods or areas are you able to volunteer in?

References
Please complete the information below. Select at least 2 people who know you well and who are familiar with your personal background, education, employment, and/or professional skills. You should not ask a family member, peer, or classmate, co-worker, or friend to serve as a reference. Consider asking work supervisors, clergy, teachers, counselors, coaches, or someone else familiar with your motivation and community involvement.

Question Title

* 15. Reference(s)

Name (First and Last Name):

Address:

Telephone:

Email:

Relationship to Applicant:

Name (First and Last Name):

Address:

Telephone:

Email:

Relationship to Applicant:

Name (First and Last Name):

Address:

Telephone:

Email:

Relationship to Applicant:

Criminal History

The application process requires a criminal history check to ensure that our patients and families are protected.

We will investigate for past sexual offenses and violent crimes that would have a direct bearing on your service.

This background check will entail our search of the National Sex Offender Registry and an FBI criminal history check, which will require your being fingerprinted.

You will not be permitted to volunteer without supervision until the history is complete and you are cleared. The review is not lengthy, and normally is completed with two weeks.

The existence of a criminal convictions or juvenile adjudication may or may not, depending on the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you.

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* 16. Have you ever been convicted of a crimes (excluding minor traffic violations)?

Yes

If yes, please describe.

Certifications:

By submitting this application:

I certify that all answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at a volunteer acceptance decision.
I understand that criminal background and National Sex Offender Registry checks will also be conducted.
I understand that I will required to submit to a physical examination, including drug and alcohol testing.
I understand that false or misleading information given in my application or interview(s) may result in disqualification or termination as a Hospice volunteer.