Amitabha Hospice Service
Volunteer Application Form
Application Form for Volunteer Support Companions in Auckland, NZ
Please Note: Applicants must live in Auckland, New Zealand and have a New Zealand Resident Permit or New Zealand Citizenship.
Your Full Name
Your Preferred Name
Your Address
Email
Mobile
Work Phone
Home Phone
Date of Birth
M/F
Residency Status
NZ Citizen
Permanent Resident
Work Visa
Student Visa
Occupation
Employment Status
Full-Time
Part-Time
Not Working/Retired
Previous Work or Skills that you feel are relevant
Would you be happy to visit an elderly or chronically ill patient as well as a terminally ill one?
Yes
No
How many hours could you contribute per week? (Minimum 2 hrs excluding travel)
Which Days?
Do you speak any other languages besides English? If so please list them here.
What is the source of your emotional or spiritual support in your life?
Do you have your own car and NZ drivers license?
What suburbs or how far are you happy to travel?
Please describe any health problems that may affect your capability or availability?
Have you had a recent bereavement within the last two years? If so, then how recently, and in what relation to you? (parent, friend, partner, etc?)
Have you ever spent time with someone who was sick, dying, or bereaved?
What motivates you to become a Amitabha Hospice Volunteer Support Companion?
What would you personally want to gain from this training?
Do you have any previous training related to grief, death, and dying?
Any other skills that you feel you could offer? (e.g. typing, bookkeeping, translating, fundraising, massage, cooking?)
Where did you hear about Amitabha Hospice?
Submit