Friends in Deed Volunteer Application
CORE Community Resources
14 South Broad St
PO Box 1530
Bayfield, WI 54814
715-779-3457 | office@corecr.org | www.corecr.org
Email address *
Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Address *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Emergency Contact (Name, Phone Number, and Email) *
Your answer
Services I would be willing to provide
If you are willing to provide transportation, please answer the four following questions
You will need to provide proof of valid auto insurance. Please bring a copy of your insurance card to your orientation.
1. Which state(s) do you hold a driver's license?
Your answer
2. Driver's license number
Your answer
3. Do you have any driving restrictions?
4. Do you have liability insurance equal to or greater than the minimum limits required by the State of Wisconsin and agree to keep that coverage on your auto while volunteering?
Background Information Disclosure
In order to maintain liability Insurance, CORE is required to perform background checks on all volunteers. By entering your initials in the 'other' box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
1. Were you ever known by any other names (including married or maiden names). If yes, what names have you used? *
Your answer
2. I understand under penalty of law that the information provided above is truthful and accurate to the best of my knowledge. I also understand the screening requirements mentioned above, and authorize CORE Community Resources to process the paperwork for the criminal background check and driver's license check. *
Required
Liability Coverage
By entering your initials in the 'other' boxes below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
General Liability: I understand that I may not have coverage for my activities as a volunteer for CORE. *
Required
Bondability: I understand that I am not bonded and that I should not handle money or property for the care receiver or the care receiver's family. *
Required
Auto insurance: I understand that I must provide my own automobile insurance and that CORE’s insurance does not necessarily provide coverage for me. *
Required
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