Hospice Volunteer Form

To protect the safety and security of those we serve UR Medicine Home Care will conduct reference and background checks for all potential volunteers. Your signature on the Authorization of Disclosure form authorizes UR Medicine Home Care to conduct a background check to obtain information through criminal record inquiries, public records, and driving record.

If you would like to volunteer at one of the hospice locations UR Medicine Home Care services, please fill out the form below.

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Your Information

Employment Information

Education and Interests Information

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Emergency Contact Information

Personal References

Please provide a completed address, as references are verified by mail. Please exclude family members.
First Reference
Second Reference

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Areas of Interest

(i.e. licensed manicurist, hairdresser, massage therapist)

Affirmation

Please check the box below to verify you are not a spambot and that you are interested in working with us to care for our patients.