Volunteer Form VINTAGE HOUSE SENIOR CENTER VOLUNTEER APPLICATION Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Home Phone*Cell Phone*About YouGenderMaleFemalePrefer Not to AnswerDate of Birth (optional) Date Format: MM slash DD slash YYYY Interests / Hobbies / Skills / Clubs and OrganizationsEducation (highest level) and Name of SchoolPersonal or Professional Reference (1)(Non-Relative)Email PhonePersonal or Professional Reference (2)(Non-Relative)Email PhonePersonal or Professional Reference (3)(Non-Relative)Email PhoneIn Case of EmergencyAre you willing to volunteer in times of disaster?* Yes No Emergency Contact to NotifyRelationshipCell or Daytime PhoneDo You Have Any Physical Limitations?Be specific. If none, write noneVolunteer ExperienceHave you volunteered before? Yes No Please describe the position and type of work performedAgencyMay we contact the Agency?YesNoPhoneAddressEmployment HistoryAre you currently employed* Yes No Retired Name of Current or Most Recent EmployerPlease describe the position and type of work performedMay we contact this employer?YesNoPhoneEmail How Would You Like to Help?Ideal volunteer hours per week or monthPreferred Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday I am interested in volunteering for...(check all that apply):* No Preference: use me where you need me! Teacher/Presenter LIMO driver Front Desk Soup for Seniors Library Bingo Decorating Musicians Writing Food Prep / Baking (Regular) Food Prep / Baking (Holiday Meals) Holiday Events Services for Seniors Social Media/Marketing If asked, are you able to provide a valid driver's license and proof of insurance? Yes No Are you willing to use your automobile if the volunteer position required one?* Yes No
