Senior Services Volunteer Application Form SECTION 1: VOLUNTEER INFORMATION

Senior Services Volunteer Application Form
SECTION 1: VOLUNTEER INFORMATION

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

Emergency Contact:

First NameLast Name

Phone Number

Area CodePhone Number

Languages Spoken:

If other, what?

SECTION 2: VOLUNTEER ASSESSMENT
Employment and Volunteer History (information used for matching with client

Current Occupation:

Volunteer Experience:

Relevant Training/Experience:

Volunteer Interest

Where did you hear about the Senior Services volunteer programs?

What appeals to you about volunteering?

What goals do you have for this volunteer experience?

Do you have a geographic preference for where you volunteer?

Do you have any health concerns that might affect your ability to perform a volunteer role? (allergies, physical limitations, etc.)

Volunteer Availability

How much time would you like to contribute? (we request that you contribute a minimum of 1 to 2 hours per week)

SECTION 3: CHARACTER REFERENCES AND POLICE RECORDS CHECK

To ensure the safety of our clients the Senior Services carefully screens all volunteer applicants. As part of this process, you are required to provide two character references from people who are not related to you. A police records check is required. We will process your applications upon receipt of your character references and police records check.

Reference # 1:

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Number

Reference # 1 Information:

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

SECTION 4: AUTHORIZATION
The information provided through the volunteer application and approval process is confidential and will be used only for the administration of your application and resulting volunteer work with the SWSVS. Your completion and signature of this application form authorizes the SWSVS to contact your references.

Signature of Applicant

Date

MonthDayYearHourMinutesAM/PM Option

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