Application Form
for Volunteer Support Companions in Auckland, NZ
Name      Preferred Name:
Your E-Mail Address:    
Phone: Work      Phone: Home
Phone: Mobile    
Date of Birth      Present Age
M/F      Are you employed?
Occupation      Working full or part time
Previous Jobs / Skills
Would you be happy to visit an elderly or chronically ill patient as well as a terminally ill one?
How many hours could you contribute per week? (Minimum 2 hrs excluding travel)      Which days?
Do you speak any other languages besides English?      Which languages?
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 yes, when 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 volunteer Amitabha Hospice Caregiver?
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?)
Amitabha Hospice complies fully with the Privacy Act. Thank you for completing this questionnaire. We will contact you for an interview before the next training program
Please click below to prove you are not a robot, and hit "Submit Application"
Contact Information:
Amitabha Hospice
44 Powell St.
Avondale 1007
Auckland, New Zealand
PH: 64-9-828-3321


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