Adult Volunteer Application

Heart of Georgia Hospice needs volunteers to help provide the best care to our patients, families, and community. If you’re interested in working with one of our volunteer programs, submit an application to our Volunteer Coordinator using the form below. A printable version of the below application should be available soon.

All fields required unless otherwise noted.

Personal Information

Volunteering Information

Which days and hours are you available to volunteer? (Select all that apply.)
Sunday morningsSunday afternoonsSunday eveningsMonday morningsMonday afternoonsMonday eveningsTuesday morningsTuesday afternoonsTuesday eveningsWednesday morningsWednesday afternoonsWednesday eveningsThursday morningsThursday afternoonsThursday eveningsFriday morningsFriday afternoonsFriday eveningsSaturday morningsSaturday afternoonsSaturday evenings

What areas are you willing to travel to for volunteer assignments? (Select all that apply.)
Houston County (Warner Robins, Perry, Kathleen)South Bibb County (Harley Bridge Area)Peach County (Ft. Vally, Byron)Crawford County (Roberta)Pulaski County (Hawkinsville)Taylor County (Butler, Reynolds)Macon County (Marshallville, Montezuma)Bleckley County (Cochran)Warner Robins Thrift StoreByron Thrift Store

Why do you want to volunteer for hospice?

Do you have any restrictions that would affect your volunteer assignments?

In what capacity would you like to volunteer?

Hospice-Patient Advocates
Patient's Residence OnlyCompanionshipRunning errandsRespite (Sitter)Light housekeepingLight cookingYard workLight maintenance

Thrift Stores
Byron Thrift StoreWarner Robins Thrift Store

Bereavement Services
VisitationTelephoningWriting cars/lettersGrief support groupsCamp Wings

Office Support
Answering telephonesErrands/deliveryFilingLight maintenance

Marketing/Public Relations and Special Events
Event setup or takedownDecoratingEvent host/hostessPhotographyErrands/deliveryFundraisingCrafts

Experience

Please list any work and/or volunteer experience from most recent to oldest.

Experience 1

May we contact this employer for a reference check?

Experience 2 (Optional)

May we contact this employer for a reference check?

Experience 3 (Optional)

May we contact this employer for a reference check?

Please indicate any special skills, experience, and/or hobbies:

General Office
TypingFilingAnswering phonesCopying/duplicatingAssembling materialsData entryComputerOther

Arts and Crafts
SewingKnittingCrochetQuiltingScrapbooksPhotographyPaintingFlower arrangingOther

Maintenance
PlumbingElectricalPaintingConstructionGeneral fix-itOther

Yard Work
MowingRakingPruning/trimmingGardeningLandscapingOther

Programs
Microsoft WordPowerPointExcelAccessPublisherAdobe InDesignPhotoShopIllustratorAudio editingVideo editingOther

Music and Entertainment
SingingString instrument(s)Woodwind instrument(s)Brass instrument(s)Percussion instrument(s)Keyboard instrument(s)MimeDanceDrama/theaterWritingFilmOther

Miscellaneous
CookingBakingReadingSportsHorseback ridingExercisePets/animalsOther

Personal References

Please list two references who have known you for at least two years. Do not list family members as references.

Reference 1

Relationship

Reference 2

Relationship

SIGNATURE

I certify that the answers given on this application are true and complete to the best of my knowledge. I hereby give Heart of Georgia Hospice, Inc. permission to conduct a background check. I agree to submit to a drug screening. I understand that volunteer placement is contingent upon the results of the background check and drug screening, and upon completing all initial and future requirements set forth by Heart of Georgia Hospice, Inc. I understand entering my name as an electronic signature is the equivalent of a physical signature.

Please enter your full name as an electronic signature.

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