Volunteer Application

Step 1 of 3

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Your Name*

First Last

Your Address*

Street Address City State ZIP Code

Home Phone Number*

Your Email Address*

Preferred Email Address*

Date of Birth*

MM slash DD slash YYYY

You must be 18 years Old

Ethnicity (This helps us when applying for grants)

Mark only one oval.

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Other

Gender*

Mark only one oval.

Male

Female

Other

Preferred Method of Contact

Check all that apply.

Phone Call

Text

Which volunteer opportunity are you interested in?*

Feel free to select more than one volunteer opportunity. However, if you have limited time due to personal or work obligations, please do notoverextend yourself by signing up for more than one volunteer opportunity.

Board Member

Committee Member

Event Planning

Friendly Visits

Fundraisers

Grant Writer

Handyman

Light Housework

Shopping/Errands

Social Phone Calls

Transportaion

Yard Work

Why are you interested in volunteering with Neighborhood Companions? What do you hope to gain from your volunteerexperience?*

Volunteer Availability: Preferred Days

Monday

Mon

Mornings

Afternoons

Evenings

Tue

Tuesday

Tue

Mornings

Afternoons

Evenings

Wed

Wednesday

Wed

Mornings

Afternoons

Evenings

Thu

Thursday

Thu

Mornings

Afternoons

Evenings

Fri

Friday

Fri

Mornings

Afternoons

Evenings

Sat

Saturday

Sat

Mornings

Afternoons

Evenings

Sun

Sunday

sun

Mornings

Afternoons

Evenings

Please share a few of your interests, skills, languages, and hobbies.*

Services

Transportation

Companionship

Social

Do you smoke?*

Mark only one oval.

Yes

Are you allergic to pets?*

Mark only one oval.

Yes

Do you have a car?*

Mark only one oval.

Yes

Do you have a valid drivers license? Is your license currently suspended or expired?*

Mark only one oval.

Yes

Vehicle Year, Make and Model*

List any special considerations for your placement (distance from home, preference for age or gender of care receiver, etc). If not applicable type N/A.

How did you learn about Neighborhood Companions?*

List any special considerations for your placement (distance from home, preference for age or gender of care receiver, etc). If not applicable type N/A.

Do you have any physical condition that may limit your volunteer activities?*

Mark only one oval.

Yes

If you have any physical condition that may limit your volunteer activities, please describe.*

If not applicable, please type N/A.

Have you ever been convicted for violation of any laws?*

Mark only one oval.

Yes

Please list education, training and/or certifications received that is relevant to your role as a Neighborhood Companions volunteer:*

If not applicable please type N/A.

Please provide at least one Emergency Contact*

Please include the following information for each reference: first and last name, phone number and their relationship to you.

I hereby give consent to contact my references and to conduct a routine background check if selected for a volunteer position.*

Please type your initials to confirm consent.

I hereby certify that the information on this application, to the best of my knowledge, is true and I understand that any misrepresentation or willful omission of facts is cause for immediate dismissal.*

Upload Your Resume

Max. file size: 50 MB.

Please provide at least 2-3 References*

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Join us in creating positive change, one volunteer at a time

Volunteer Requirements: