Meals on Wheels Volunteer Application
Ready to help deliver hot meals & a warm smile?
Email address *
First Name *
Your answer
Last Name *
Your answer
Home Address - street, city, zip code *
Your answer
Cell Phone *
Your answer
Home Phone
Your answer
Company
Your answer
Optional : Gender
Optional: Are you a Veteran
Emergency Contact - name, phone number, relationship *
Your answer
Member of existing Volunteer Group:
Your answer
Desired Delivery Area - check all that apply
I am interested in
Days Available - check all that apply
Where did you hear about Meals on Wheels?
Your answer
Do you speak any languages other than English?
Your answer
Do you have any limitations that may cause difficulty performing essential functions of the volunteer position? If yes, explain:
Your answer
Have you ever been arrested or convicted of any offense? If yes, please explain providing dates, charge, disposition, and other appropriate details. *
Your answer
Required for Volunteer Drivers : Automobile Insurance Company
Your answer
Required for Volunteer Drivers : Insurance Policy Number
Your answer
Required for Volunteer Drivers : Driver's License Number
Your answer
Required for Volunteer Drivers: State that driver's license was issued in:
Your answer
I have read the Meals on Wheels, Inc. Volunteer Code of Ethics in the Driver Guidelines Brochure and agree to abide by these guidelines set by the Meals on Wheels, Inc. Board of Directors. *
I agree that all client information I receive, whether obtained by direct contact with clients and their families or information from MOWI staff is to be held in strict confidence in order to protect the rights of all clients. *
Additionally, I agree to identify and hold Fort Bend Seniors Meals on Wheels harmless of and from any and all claims, demands, losses, suits, or all other damages of any kind arising from my activities as a volunteer for Fort Bend Seniors Meals on Wheels. *
Date of birth *
MM/DD/YYYY
Your answer
Last 4 digits of Social Security Number *
This is required for the background check we run on all volunteers. Information is stored securely and never distributed or accessible to outside parties.
Your answer
Type full name to authorize background check (details above) *
Your answer
Date of Application (Today's Date) *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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