Cascade Health Volunteer Application

Cascade Health - Volunteer Services

2650 Suzanne Way, Suite 200 Eugene, OR 97408

Phone: 541-228-3081
Fax: 541-228-3182
pfeist@cascadehealth.org

Once we receive your completed application, we will call you to shcedule an informal interview at your convenience.

Name:

Phone:

Date:

Address/City/State

Email:

Occupation:

Employer:

Employer Phone:

Emergency Contact

Name/Phone

Is there any situation that may affect your ability to function as a volunteer, or that would require an accommodation in order for you to safely and competently perform in this capacity?

Yes No

When are you most available:

Mornings

Afternoon

Evenings

M-F

Weekends

How many days per week would you like to volunteer?

How did you learn about Cascade Hospice?

Which of the following are of interest you:

General Cascade Health volunteer opportunities

Pete Moore Hospice House volunteer opportunities

Recent Work Experience: Include Employer (most recent first) Dates of Employment & Position

References: List three people who are not related to you and can speak to your character. Please include at least one professional reference.

Name:

Relationship:

Phone:

Name:

Relationship:

Phone:

Name:

Relationship:

Phone:

Volunteer Experience: List any previous volunteer experience.

Add new row

Other skills or interests you’d like to share as a volunteer:

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