Meals-on-Wheels
VOLUNTEER
APPLICATION
PERSONAL INFORMATION: DATE OF APPLICATION: __________________
NAME___________________________________PHONE (H)__________________(W)_________________
ADDRESS_____________________________________CITY__________________________ZIP_________
EMAIL ADDRESS_________________________________________________________________________
IN CASE OF EMERGENCY CONTACT:
NAME_______________________________________RELATIONSHIP__________________________
PHONE (H)________________________________PHONE (W)_________________________________
REFERENCE (Professional Preferred)_________________________________PHONE____________________
EMPLOYER (If retired please indicate former employer)_____________________________________________
Are you representing a group or club? _____NO _____YES (If YES, please specify the group)_______________
Do you have a Virginia Driver’s License? ______NO ______YES (please show license to recruiter)
Do you have current Auto Insurance? _______NO_______YES (specify company)________________________
What day(s) can you volunteer? € MON € TUES € WED € THURS € FRI
€ WEEKLY € BIWEEKLY € MONTHLY
REFERRAL SOURCE: € Newspaper € TV € Flier € Volunteer € LOA News € Other_____________
Can you support Meals-on-Wheels in other ways: € Mentoring € Fundraising Events/Committees
€ Staffing Volunteer Booths € Public Speaking € Driving in Snow
Meals-on-Wheels Site _______________________________Date Referred_____________________________
Mail List __________YES __________NO Name Tag __________YES __________NO