Volunteer Application

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email Address(Required)

Present Working Status(Required)

Full-time

Part-time

Retired

Times Available(Required)

Mornings

Afternoons

Dates Available(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Previous Work Experience(Required)

Dates(Required)

Type of Work(Required)

Other Interests, activities, organizational involvement(Required)

Special talents, office skills(Required)

Foreign languages spoken(Required)

Highest level of education(Required)

How did you hear about this volunteer opportunity?(Required)

Are you comfortable working with older adults?(Required)

Have you, or any member of your family, received services from Aging Care Connections?(Required)

Which of the following volunteer experiences interest you?(Required)

Fundraising Events

Front Desk Receptionist

ThirBenefits Assistantd Choice

Filing

Data Entry

Follow-up calls

Congregate Dining Volunteer

Publication Editor

Other

Please provide two references (Not Relatives)

Who should we contact in case of an emergency?

Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Please be advised that we complete a background check prior to accepting any new volunteer.

The information I have furnished on this application is true and complete to the best of my knowledge. I understand that all the work done for the Aging Care Connections is confidential in nature and that volunteer services are performed without compensation. I agree to hold Aging Care Connections harmless for any injury sustained by me during my time volunteering for the agency.

Because Aging Well Matters

Because Aging Well Matters

VOLUNTEER APPLICATION

Who should we contact in case of an emergency?