Welcome to the Emmanuel Hospice volunteer portal

Volunteer application

Volunteer Application
First name
MI
Last Name
E-mail
Street Address
Apt/Suite
City
State
Zip/postal
Phone
From:
To:
If seasonal resident, dates you are in Michigan:
(DD/MM/YYYY)
(DD/MM/YYYY)
Seasonal Address
Apt/Suite
City
State
Zip/postal
Emergency Contact Information
Name
Relationship
Address
Apt/Suite
City
State
Zip/postal
Phone
Employment Information
Are you retired?
Date of retirement
If employed, place of employment
References
Please list three personal references below. Relatives may not be used as references
#1
Name
Phone
E-mail
Address
City
State
Zip/postal
#2
Name
Phone
E-mail
Address
City
State
Zip/postal
#3
Name
Phone
E-mail
Address 1
City
State
Zip/postal
Other Information
Have you ever been convicted of a misdemeanor or a felony, or pled no contest, plead guilty to a crime, entered a pre-trial intervention program or a similar program, been fined or placed on probation for a misdemeanor or felony, regardless of adjudication?
If you answered "yes" to either of the above questions, please explain:
How did you hear about us? (please choose one)
If "Other", please describe:
Hours available:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Position/activity of interest:
How many hours are you willing to volunteer per month?
Certify:
I certify that the information on this application is true and correct, to the best of my knowledge. I also understand that Emmanuel Hospice is a drug free workplace.
Name:
Date:
*Please note that due to state and federal statutes governing hospices and healthcare facilities, we are required to perform criminal background searches on all volunteer candidates. All searches are done confidentially, utilizing government databases. The results of these searches remain strictly confidential.