Fort Bend Seniors Meals on Wheels Adult Volunteer Application
Email address *
Have you or someone in your household traveled domestically or internationally in the past 4 weeks? Due to Coronavirus concerns, any travelers will be asked to postpone volunteering with our agency for up to 14-21 days. Thank you for understanding! *
What is your first name *
What is your last name *
Home Address - Street *
City/Zip Code *
Cell Phone (###-###-####) *
Home Phone (###-###-####) (if applicable)
Company
Work Status:
Clear selection
Optional : Gender
Clear selection
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 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
Required for Volunteer Meals on Wheels Delivery Drivers : Driver's License Number
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 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.
Clear selection
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
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.
Type full name to authorize background check (details above) *
Date of Application (Today's Date) *
MM
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A copy of your responses will be emailed to the address you provided.
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