Bloomington Meals on Wheels Volunteer Application

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Name *

Address *

City *

State *

Zip Code *

Preferred phone number *

Phone Type *

Home

Cell

Alternate phone number

Phone Type

Home

Cell

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I consent to receive text messages related to my volunteer activities at Bloomington Meals on Wheels, including cancellations, schedule reminders, or route updates. Standard message and data rates may apply. *

Yes

Required

Email Address *

Date of Birth *

Which volunteer opportunities are you interested in (Check all that apply)

Meals on Wheels Delivery Driver - Deliver prepared meals to Bloomington residents who are homebound and unable to prepare nutritious meals due to chronic illness, injury, serious disability or advance age. Routes take 1 -1.5 hours, starting at 11:00 am.

Groceries to Go Delivery Driver - Deliver bags of food to Bloomington residents who are unable to access other free food sources, such as pantries or Community Kitchen, due to health or transportation issues. Routes take 1-1.5 hours on Thursdays, starting at 10am.

Groceries to Go Distribution Assistant- Prepare bags of food for delivery and restock pantry shelves. Monday, Tuesday, and Thursday 10:00 am - Noon.

Days available to deliver meals, pack bags or assist in office: *

Monday

Tuesday

Wednesday

Thursday

Friday

Required

Would you be willing to drive in bad weather? *

Yes

Special Needs/ Physical limitations:

Please share an emergency contact not volunteering with you we could contact on your behalf in an emergency: their name, phone number, and relationship to you. *

In addition to being assigned to a regular day route, would you be willing to drive occasionally when a substitute driver is needed? *

Yes

Would you prefer to volunteer only as a substitute driver? *

Yes

Current employer (if retired, last employer) *

Do you have a valid driver's license? *

Yes

Driver's license number and issuing state: *

Do you have a vehicle to use for meal delivery? *

Yes

Is your vehicle legally registered? *

Yes

Does the vehicle meet minimum state insurance requirements? *

Yes

Vehicle insurance company and policy number: *

Have you ever been convicted of a felony, crime of dishonesty or untruthfulness, or a crime involving abuse of alcohol or a controlled substance? If yes, please describe in detail below. *

By writing my name below, I agree that the above statements are true and correct. I also hereby authorize Bloomington Meals on Wheels or any of its agents to perform a criminal background check or any other kind of background check. *

Date completed *

YYYY

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