Volunteer Application Form

Hospice relies on the generous contributions of our amazing volunteers. Thank you for your interest in applying to become a Hospice volunteer.

Please read the following information and complete this form

As part of the requirements for volunteering for our organisation, we need some information from you via:

Volunteer Application Form
This information is needed by Hospice Mid-Northland to assist in your placement in the volunteer team, for contact details in the case of an emergency and for our statistical purposes.
Ministry of Justice Security Form
This form is needed to ascertain any security issues that may impact on volunteer placement. This ensures that Hospice Mid-Northland is protected when working in the public arena.
A copy of your Driver's License and/or Passport
For the identification and/or for those driving on our behalf. This can be photocopied at Hospice Mid-Northland.

Volunteer Form

Please complete and submit electronically to apply to become a Hospice Mid-Northland volunteer. Alternatively, you can print the electronic copy below or pick up a hard copy form from the Hospice Mid-Northland office.

The information you supply will not be disclosed to any other party or organisation. It will be held on a secure database in a locked facility and you may request a copy of your information at any time.

Click here to download pdf

Volunteer Roles

There are many ways that you can help as a Hospice Mid-Northland volunteer, including:

Supporting patients:			In their own homes. Non-clinical support (eg company, reading, comforting presence).
Special Time Therapist:			Providing complementary therapies in Kerikeri or Hokianga. Must hold certificates of training/practice.
Special Time Hostess:			Ensuring patients/family catered for and lounge clear and welcoming in Kerikeri or Hokianga.
Shop Volunteer:			Full-time, on-call, backroom support or team leaders.
Sorting Centre Volunteer:			Sorting, cleaning and pricing donated goods. Full-commitment or on-call.
Clearance Shed:			Open and close the clearance shed ready to sell donated goods.
Jack of All Trades:			Storeman at the Hospice Shop or Processing Centre, clearing drop-off area. Cleaning and repairing.
Lifter, Shifter Driver:			Moving our hospital loan equipment and/or shop donations.
Fundraising Events Support:			Coordinating, baking or helping on the day (for one or more events as wished).
Hospice Office Support:			Answer phones and assist with folding and labelling of newsletters etc.
Grounds and Maintenance			At Hospice Mid-Northland on 464 Kerikeri Road. Gardening, window washing, working bees, trade - painting, plumbing etc
Catering, Baking			Provide baking for the freezer or events when required and help at functions.

Please select the appropriate primary volunteer role in the form below and state what other roles you may be able to help Hospice with.

Name

Address

Post Code

Email Address

Date of Birth

Home Phone

Mobile Number

Volunteer Role

Volunteer Other (please describe)

Please advise what location(s) you can volunteer

Please tell us your work experience

Are there other interests and skills you could bring to Hospice?

What motivated you to volunteer for Hospice?

What days are you available to volunteer?

Are you available during school holidays?

Do you agree to attending Hospice Induction and other training courses as required? (Check box for YES)

Emergency Contact Information: Name of General Practitioner Doctor (GP)

Emergency Contact Information: Primary contact person, relationship and telephone

Emergency Contact Information: Secondary contact person, relationship, telephone

Please list any medical conditions/limitations that might affect your work

Please supply the name, address and contact details of a referee (who is not a close relative)

If placed in a volunteer position, I agree to work within Hospice protocols, as outlined in the Volunteer Information Sheet supplied with this application form and during the training. (Check box for YES)

Signed by (Please enter your name):

Dated:

Address

Thank you for your generous offer to become a Hospice Mid-Northland volunteer. We will be in contact with you soon.

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