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Volunteer Application
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Are you retired?
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Volunteer Experience
Pertinent health issues/Physical limitations
Are you currently dealing with someone who is terminally ill?
Direct Patient Support Areas of Interest
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Computer Skills - Check all that apply
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Please provide two references. Include their full name, email address, relationship, and a contact number.
Reference #1 - Name
Name
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Last
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Email
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Phone
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Reference #2 - Name
Name
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Numbers
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Veteran Status
Did you (or your spouse or family member) serve in the military?
Yes
No
Did you serve on active duty?
Yes
No
Did your service include combat, dangerous or traumatic assignments?
Yes
No
Did your spouse serve on active duty?
Yes
No
Do you have any immediate family members that served or are serving in the military?
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No
Comments?
Military Background
In which branch of the military did you serve?
Army
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Air Force
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Reservist or National Guard
Merchant Marines during WWII
Other
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In which war era or period of service did you serve?
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Overall, how do you view your experience in the military?
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I agree, in typing my First and Last name (below this statement), the information provided in this application is accurate and true to the best of my knowledge. Furthermore, Hospice of the North Coast may use this attestation statement as my electronic signature.
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