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Volunteer Application

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“My hospice training redirected my life and opened doors that have transformed me.”

Join Our Team of Compassionate Volunteers! Your support makes a meaningful difference in the lives of our patients and their families. Fill out our volunteer application to start your journey in providing comfort and care to those in need.

Name
Address
I agree to receive electronic communication at the provided email address.
Full Time or Part Time?
Highest Level of Education
Languages Spoken
I prefer to volunteer at: (Check All That Apply)
I am comfortable sitting with a patient who is actively dying with no family present?
Assignment Preferences: (Check All That Apply)
Emergency Contact
Professional Reference: Most Recent Employer
Professional Reference:
Professional References:
Volunteer Agreement: I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that by submitting this application I authorize inquiries to be made concerning my employment, character, and public records for the purpose of determining my suitability as a volunteer. I agree to respect the confidentiality of any client information I acquire in the course of my volunteer activities with Hospice of Lake Cumberland. As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professional in the field in which I work. I like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me. I understand that any information that is disclosed to me while assisting Hospice of Lake Cumberland is confidential. I interpret “volunteer” to mean that I have agreed to work without compensation in money but having been accepted as a volunteer worker. I expect to do my work according to standards set forth in the Volunteer Policies Handbook. I hereby certify that statements made on this application are true and correct to the best of my knowledge. I understand that, by submitting this application, I authorize inquiries to be made concerning my employment and character for the purposes of determining my suitability as a volunteer. I affirm I have read the Code of Ethics for Volunteers and agree to abide by its regulations. Standards of Conduct: I will be honest, sincere and take responsibility for my actions, give excellent care and service at all times to patients, families, referral sources, community partners, team and organization, follow Hospice of Lake Cumberland confidentiality and security policies demonstrate open communication to build trust and team environment, meet established Deadlines or follow-up with appropriate individuals, prior to the deadline, when the time frame cannot be met be on time, be prepared, maintain regular attendance and be flexible to meet the needs of my department, team and organization. I will have a friendly attitude, make eye contact and respond with sensitivity and understanding, cultivate an attitude of support and encouragement for my team, department and organization, be solutions oriented avoid gossip and spreading negativity to others, give support and encouragement to others, be flexible, open to change and maintain a wholesome sense of humor, be cooperative and collaborative in building and maintaining positive relationships with my team department and organization. I will acknowledge patients and families, introduce myself, explain my purpose, planned duration of visit and express appreciation as appropriate, provide direct, respectful and accurate information to IDG, provide support and assistance to patients according to my role and function as a volunteer, communicate any concerns or changes in condition of patient with the IDG and Director of Volunteer Services, end each conversation with a recap of visit details and plan of future visits, communicate with all appropriate personnel when visiting another facility and document those contacts, answer all questions directed to me and, when unable, clearly explain what follow-up may be anticipated, allow each person to make his/her point or express frustration without interruptions, distractions or taking things personally, not hesitate to ask questions when in doubt, wear my ID badge where it is clearly visible, respond to all calls according to HLC policy, take responsibility for reviewing all communicated information in a timely manner, provide timely and accurate documentation. I will use language that is not demeaning to anyone’s heritage, race, creed, gender, age, disability and/or sexual orientation demonstrate respect for co-workers by actively listening, avoiding assumptions and premature conclusions, maintain a healthy balance between work and home life for the benefit of those I serve and myself, ask permission of patients and families, with regard to touch, time and space, be respectful of co-workers and our community partners by asking permission to access resources, practice the principle of “treating others as you want to be treated” in relationships within the organization and those we serve, and actively involve others as appropriate in decisions that impact them.
Photo Release: I understand that volunteers may be photographed, filmed, and/or videoed by staff, volunteers, or designated individuals for Hospice of Lake Cumberland. Photographs/film/video may be used for the purpose of publicity and/or advertising about the Hospice and Hospice care for a variety of media purposes, including, but not limited to, television, website, social media, newsletters, etc. Volunteer’s names may or may not be disclosed. Agreement to Assure Confidentiality: I, understand that all information regarding patients, families and business issues of Hospice of Lake Cumberland must be kept confidential. I understand that I may not release any information regarding patient information without expressed written consent from the patient or the patient’s legal representative. I understand that I may not discuss or release any information regarding business practices or issues without the consent of the Executive Director or designee. I am aware of and fully understand that any violation of confidentiality will result in disciplinary action, which may include dismissal by Hospice of Lake Cumberland. I understand that as a volunteer serving in the patient’s home I may receive confidential information concerning illness, death, and accidents. I understand that I am expected to maintain confidentiality concerning all patient-related matters. I understand access to records is limited to those whose job duties require access.
Clear Signature

Thank you for your interest in becoming a Hospice Volunteer

Volunteers are at the heart of our hospice patient care team. Because we provided care during an intense, emotional, and crucial time, volunteers make a significant impact.