Fort Bend Seniors Meals on Wheels Adult Volunteer Application
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Email *
First name *
Last name *
Home Address - Street *
City/Zip Code *
Cell Phone (###-###-####) *
Home Phone (###-###-####) (if applicable) *
Company
Work Status: *
Optional : Gender *
Are you a Veteran? *
Emergency Contact - Name, Relationship *
Emergency Contact Phone Number *
Member of existing Volunteer Group(s):
Desired Delivery/Volunteer Area - check all that apply *
Required
I am interested in *
Required
Days Available - check all that apply *
Required
Where did you hear about Fort Bend Seniors Meals on Wheels? *
Do you speak any languages other than English?  Check all that apply *
Required
Do you have any limitations that may cause difficulty performing essential functions of the volunteer position? If yes, explain: *
Have you ever been arrested or convicted of any offense?  If yes, please explain providing dates, charge, disposition, and other appropriate details. *
Required for Volunteer Meals on Wheels Delivery Drivers: Automobile Insurance Company
Required for Volunteer Meals on Wheels Delivery Drivers : Insurance Policy Number and Expiration Date
Required for Volunteer Meals on Wheels Delivery Drivers : Driver's License Number and Expiration Date
Required for Volunteer Meals on Wheels Delivery Drivers: State driver's license was issued: *
Are you CPR/First Aid Certified *
CPR/First Aid Expiration Date (if applicable)
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I agree that all client information I receive, whether obtained by direct contact with clients and their families or information from MOW 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
Type full name to authorize background check *
Today's Date: *
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A copy of your responses will be emailed to the address you provided.
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