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FAITH HOSPICE MISSION STATEMENT

In fulfilling God's calling to serve others, we will:

  • Serve with love and compassion
  • Commit to excellence
  • Follow Christ's teaching and example in all we do.
PERSONAL INFORMATION
EMERGENCY CONTACT INFORMATION
REFERENCE 1 OF 2 (no relatives - MUST provide email and/or phone)
REFERENCE 2 OF 2 (no relatives - MUST provide email and/or phone)
Authorization for a Criminal Background Check
An investigation consumer report consisting of a criminal conviction background check will be obtained on all new employees and volunteers of Faith Hospice. This report will be used for employment and volunteer purposes only. You have the right to make a written request within a reasonable period of time for information concerning the nature and scope of the investigation. In the event you desire this information, please contact the Volunteer Services Office. This Notice is authorized by the Fair Credit Reporting Act, Section 604(b).

I authorize Faith Hospice to conduct a criminal background check with the State Police, County Sheriff Departments, and/or a Consumer Reporting Agency for the purpose of determining my suitability for employment/volunteer work with Faith Hospice.  I have listed below all crimes for which I have been convicted, including the date of such convictions, as well as any pending felony charges.  I acknowledge that any omission or falsification of this form shall be grounds for discharge if I am employed or assigned as a volunteer.
ADDITIONAL INFORMATION
How frequently can you volunteer:
You must be at least 18 years of age in order to volunteer.
Attestation of Application Answers and Information Provided
I hereby represent that the above information is true and complete. I have not withheld anything from this application which, if disclosed, would affect this application unfavorably. I understand that if Faith Hospice should determine at any time that any of the requested information was withheld by me, or that any of the statements given in this application were false or misleading, I may be refused the opportunity to volunteer, or, if currently volunteering, would be discharged immediately. I understand that I will be free to leave my volunteer position at any time with or without cause; and I understand and agree that Faith Hospice also may terminate my volunteer duties at any time with or without cause.

If I become a Faith Hospice volunteer, I will comply with all rules, regulations, policies and communications directed to volunteers.  I hereby authorize Faith Hospice to conduct a routine criminal history check (if I am 18 or older), and thoroughly investigate my work, medical and personal history that is job-related. I also authorize Faith Hospice to communicate with the references I provided above.  If arrested or convicted for any of the following criminal offenses-abuse, neglect, assault, battery, theft, fraud, criminal sexual conduct, or any felony-I agree to immediately report it to the Volunteer Services Department.

I understand that I may not be selected as a volunteer for any reason, and that if I become a volunteer, my status as such may be terminated at any time for any reason.
Full Legal Name (e-signature)