Maxcare Hospice

(714) 844-7777

Volunteer Application




    Date of birth:
    Today's Date:


    1. Are you 18 years of age or older?

    2. Do you speak a language other than English?

    3. Have you ever been convicted of a crime?
    If yes, for what, when and where?

    4. How did you hear about the Maxcare Hospice Volunteer Program?

    5. What type of volunteer services/skills are you interested in providing?

    6. What are your special skills, abilities, training, experiences, hobbies and interests?

    7. Preferred day(s) to volunteer:

    8. Preferred time to volunteer:

    9. Have you experienced a significant loss in the past year?

    10. What do you know about Hospice?

    11. Please provide two (2) personal references:

    Personal Reference 1




    Personal Reference 2




    12. In case of emergency, contact



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