Bloomington Meals on Wheels Volunteer Application
Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
Date of Birth *
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Days available to deliver meals: *
Required
Would you be willing to drive in bad weather? *
Special Needs/ Physical limitations:
Your answer
In addition to being assigned to a regular day route, would you be willing to drive occasionally when a substitute driver is needed? *
Would you prefer to volunteer only as a substitute driver? *
Current employer (if retired, last employer) *
Your answer
Do you have a valid driver's license? *
Driver's license number and issuing state: *
Your answer
Do you have a vehicle to use for meal delivery? *
Does the vehicle meet minimum state insurance requirements? *
Vehicle insurance company and policy number: *
Your answer
Is your vehicle legally registered? *
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. *
Your answer
By writing my name below, I hereby authorize Bloomington Meals on Wheels or any of its agents to perform a criminal background check or any other kind of background check. I also agree that the above statements are true and correct. *
Your answer
Date completed *
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