VOLUNTEER INTEREST FORM

Aging Services

Name

 *

Name

Last Name

First Name

Phone

 *

Phone

Primary Phoneext.

Secondary Phoneext.

Street Address

 *

Street Address

Address

City

Zip Code

.

.

Date of Birth

Email Address

How did you hear about volunteer opportunities with Aging Services? 

How did you hear about volunteer opportunities with Aging Services?

Experience/Abilities

Employment Status:

Employment Status:

Currently Employed

Retired

Unemployed

Current/Previous Occupation: 

Current/Previous Occupation:

Skills (Please check all that apply):

Skills (Please check all that apply):

Accounting	Legal	Photography
Computers	Library/Librarian	Receptionist
Data Entry	Management	Retail
Event Planning	Marketing	Teaching
Food Services	Medical	Transportation
Graphic Design

Availability: Please mark the times you are available for each day.

Availability: Please mark the times you are available for each day.

Monday Morning (8:30 am – 12:30 pm)

Monday Afternoon (12:30 pm – 4:30 pm)

Tuesday Morning (8:30 am – 12:30 pm)

Tuesday Afternoon (12:30 pm – 4:30 pm)

Tuesday Evening (4:30 pm – 8:00 pm)

Wednesday Morning (8:30 am – 12:30 pm)

Wednesday Afternoon (12:30 pm – 4:30 pm)

Thursday Morning (8:30 am – 12:30 pm)

Thursday Afternoon (12:30 pm – 4:30 pm)

Thursday Evening (4:30 pm – 8:00 pm)

Friday Morning (8:30 am – 12:30 pm)

Friday Afternoon (12:30 pm – 4:30 pm)

Saturday Morning (8:30 am – 12:30 pm)

Frequency: How often are you interested in volunteering?

Frequency: How often are you interested in volunteering?

Weekly

Monthly

One-time Event

Volunteer Opportunities: Please indicate any areas in which may be of interest. Please speak with the Volunteer Coordinator for job descriptions for each opportunity.

Aging Services:

Aging Services:

Activity Aide	Enrichment Associate	Library Aide
Bingo Aide	Front Desk Associate	Special Event Assistant
Data Entry	Gift Shop	Trip Escort

Nutrition:

Nutrition:

Café Assistant	Café Server	Flatware Wrapper
Café Hostess	Communication Associate	Home Delivered Meals

Transportation:

Transportation:

Transportation Associate

Data Entry

Dispatch Aide

Signature

 *

Signature

Your Name

Date

Thank you for filling out our Volunteer Interest Form. We will keep your form on file for 6 months and if we feel your interests match our needs, we will call you to schedule an interview and orientation.

* Confidentiality Statement and/or Background Checks are required. *

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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