Volunteer Application

Volunteer Application

Personal Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email

Are you part of a group? If so, what group? *

Availability (Check All That Apply) *

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

Times Available in the Mornings *

Times Available in the Afternoons *

Type of Volunteer

Please select the type of volunteer work that interests you: *

• Individual - this would include visiting with a resident
• Group Activity - this may include leading bingo, exercise, etc.
• Material Preparation - this may include helping get items prepared for activities
• Projects - this may include helping with festivities, parties, or special outings

Please mark the below items you would be interested in helping with, you can use the next section to describe specifically what you would like to do. For example x Games, then in the section below, "Games: Bingo, Checkers, etc." *

• Exercise
• Games
• Pet Therapy
• Sensory Stimulation
• Reading
• Outdoor Visits
• Spiritual
• Popcorn Cart
• Seasonal Decorating
• Transportation Aide
• Friendly Visitor
• Computer
• Arts/Crafts
• Music
• Mail/Writing
• Special Events
• DVD/ Video
• Lending Library
• Bulletin Board
• Other

Please describe specifically what you would like to do. *

List your special hobbies, skills, and talents *

What languages do you speak fluently? *

Volunteer work experience: *

How did you hear about us? *

Have you ever been convicted of a crime, other than a minor traffic violations, or are you currently facing any criminal charges? *

References

Name *

First

Last

Phone *

Years known: *

Name

First

Last

Phone

Years known:

Name

First

Last

Phone

Years known:

Please tell us why you want to volunteer with us: *

Agreement & Understanding

I understand that: *

• Advisory: A check of volunteer applicants' references may be made to verify the responses to the above questions for the sole purpose of ensuring the safety of residents, staff, and visitors.
• I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and active volunteer status may be terminated at any time

By typing your name, you certify that all information contained in this Volunteer Application is true and accurate to the best of your knowledge and belief; and have read, understood, and agree to be legally bound to all of the terms in the Applicant Statement and Agreement. *

Applicant's Name *

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