* = Required Information
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REFERENCE INFORMATION: Please list information for at least three references below including:

  1. Your spouse or domestic partner (i.e., if you live with a significant other/ girlfriend/boyfriend) OR a family member, if you do not have a spouse, partner, or significant other)

  2. Current or former employer or you have known for at least one year;

  3. Faculty or adviser reference

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Milwaukee Racine Kenosha Jefferson Washington Ozaukee Walworth
  SUNDAY MONDAY TUESDAY WEDNESDAY FRIDAY SATURDAY
   AM
   PM
   Overnight Vigil Volunteer
   Other
Helping Hand Volunteers Bereavement Volunteer Art Volunteer
Community Outreach Alternative Support Volunteers Alternative Support Volunteers
Pet Friends Music Volunteer Spiritual Companion
Craft Volunteer Vigil Volunteer Legacy Volunteers
Pampering Volunteer Companion Volunteer Internship Only
Volunteering another way

Holistic Home and Hospice is an Equal Opportunity Agency. All prospective volunteers will receive consideration without discrimination because of race, color, creed, age, natural origin or handicap. All information provided herein will be kept confidential. I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Holistic Home & Hospice. I certify that all information I have provided or will provide to Holistic Home and Hospice, including this application, is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained on my application will be verified by Holistic Home and Hospice. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer. At any time while involved with the Holistic Home and Hospice program, I agree to immediately inform the Holistic Home and Hospice Volunteer Coordinator of any and all infractions, violations, charges and convictions related to any civil, domestic, or criminal occurrences.

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