Volunteer Application

Volunteer Application
Are you interested in volunteering or employment?*

VolunteeringEmployment
Please visit our Careers page for employment opportunities.
Today's date:*

MonthDayYear
Date
Your full name:*

First NameLast Name
Your address:*

Street Address

Street Address Line 2

CityState

Zip Code
Your phone number:*
Your email:*
example@example.com
Date available to start:*

MonthDayYear
Date
Have you ever been convicted of a felony?

YesNo
Are you 18 years old or older?*

YesNo
Volunteers under 18 years old are required to be accompanied by a parent or guardian while volunteering. Please have your parent or guardian fill out a volunteer application as well.
How did you hear about Vivant Senior Living?*
What interests you in volunteering with seniors with dementia?*
Languages spoken:*
Preferred time to volunteer (please check all that apply)*

Days (9am-5pm)Evenings (after 5pm)Weekdays (Monday-Friday)Weekends (Saturday-Sunday)Other
Type of volunteer work you're interested in (please check all that apply)*

Phone/video calls with residentsIndividual residents visitsAssist with activity programsProvide entertainment or musicOrganize/cleanupGames/bingoDecorate for the holidaysOther
References

(Please provide three personal references.)
Reference #1
Full name:*

First NameLast Name
Phone number:*

Area CodePhone Number
Relationship:*
Years known:*
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Reference #2
Full name:*

First NameLast Name
Phone number:*

Area CodePhone Number
Relationship:*
Years known:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference #3
Full name:*

First NameLast Name
Phone number:*

Area CodePhone Number
Relationship:*
Years known:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact
Name:*

First NameLast Name
Phone number:*
Relationship:*
Disclaimer and Signature
I certify that my answers are true and completed and answered to the best of my knowledge. This also allows Vivant Management LLC to use my information to complete a background screening and any other screening required by Vivant Management LLC to evaluate my volunteer status.
Your Signature*

Clear
Should be Empty:

Volunteer Application

References

Reference #1

Reference #2

Reference #3

Emergency Contact

Disclaimer and Signature