Hospice of Davidson County
200 Hospice Way
Lexington, NC 27292
(336) 475-5444

Volunteer Application

Do you have a valid NC driver's license? *

Emergency Contact Information

Volunteer Experience

Have you ever been convicted of any unlawful offenses, other than minor traffic violations? *

Education & Speciality Training

Did you graduate?
Did you receive a degree or certificate? *
Did you receive a degree or certificate?
Are you attending school now?

Special Services & Complimentary Therapies

Please check all services or therapies in which you have experience. *

Areas of Interest, Availability and Skills

Please select your areas of interest in providing Direct Patient Family Care. *
Please select all you are interested in with Grief Support and Bereavement. *
Please select areas of interest in Non-Direct Patient Services. *
Please select the times you are available to volunteer. *
Are you available on short notice?
Are you willing to commit to volunteering at Hospice of Davidson County for a minimum of one year? *
Do you have access to transportation? *
Do you currently have an immediate family member receiving hospice care? *
Have you experienced the loss of a loved one during the past year? *
Do you have any allergies that would prevent you from providing in home care? *

Military Service

Are you or were you a member of the U.S. Military? Please select your status here. *
What was your branch of military service? *
Are you interested in serving as a volunteer in our Vet-to-Vet program? *

Employment Information

Are you currently employed? *
Are you retired? *
May we contact you at work?

Character & Professional References

Vaccination Requirement

Prior to their first day with Hospice of Davidson County, volunteers are required to either be fully vaccinated against COVID-19 or have been granted a medical and/or religious accommodation exemption, as set forth in Hospice of Davidson County's COVID-19 policy.

Code of Ethics for Volunteers

As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professionals 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 the Hospice is confidential. 

I interpret "volunteer" to mean that I have agreed to work without financial compensation.  As a volunteer worker, I expect to do my work according to the standards set forth in Volunteer Policies and Procedures.

I understand that my acceptance as a volunteer is contingent upon the successful completion of my references, criminal background/sex offender investigation and pre-volunteer drug screen.

I understand volunteers must attend a volunteer workshop requiring 12 hours of education and that Accreditation Commission for Healthcare (ACHC) requires 12 hours of continuing education annually.  I understands that I must also submit to a TB test prior to volunteering.


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 character and public records for the purpose of determining my suitability as a volunteer.