Thanksgiving Application

Thanksgiving Volunteer Application

Thank you for renewing your documentation! Questions? Email our Volunteer Programs Coordinator at vol@eldercare.org.
Your Contact Info

A red asterisk (*) denotes required fields.
Salutation
Name

First NameLast Name
Email
example@example.com
Work Email
example@example.com
Alternate Email (optional)
example@example.com
Which Email Address is Primary?
Phone Number
Format: (000) 000-0000.
Home Phone Number
Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which Number is Primary?
Company
Record Type ID
Jotform
Record Owner
Would you like to indicate your pronouns?
For example: she/her/hers, they/them/theirs, he/him/his
Emergency Contact Info
Your Emergency Contact Person

First NameLast Name
Emergency Contact relationship
Emergency Contact Email address
example@example.com
Emergency Contact Phone Number
Format: (000) 000-0000.
We love volunteers with language skills!
Do you converse in any languages other than English? If so, please select from the drop-down list:
Additional or other language skills:

- Delivery Event Volunteers
- Do you have a vehicle to drive?
  
  Other
- Do you have GPS navigation? Example: a GPS device such as Garmin brand, or a smartphone using a navigation app
  
  Other
- Do you have a cell phone?
  
  Other
- Children under age 18 are welcome to volunteer on Thanksgiving with parental supervision. Please just share their name, and date of birth.
  
  Adult children (age 18 +) should also submit an application
  
  If your students need a sign-off on community service hours, let us know!
  
  Please also let us know if you have route requests.
- Name and date of birth for each child under 18, teammate requests, and route requests:

CORI form and Government-issued Identification:

The CORI is a required background check standard for all community-based volunteers. According to MA General Laws Chapter 6 Sec 167-178B, we are required to request a CORI of potential volunteers who would meet with clients.  The CORI consists of the next 2 pages. Questions? Email vol@eldercare.org
THE COMMONWEALTH OF MASSACHUSETTS

EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY

Department of Criminal Justice Information Services

200 Arlington Street, Suite 2200, Chelsea, MA 02150

TEL: (617) 660-4640/ TTY: (617) 660-4046/ FAX: (617) 660-5973

MASS.GOV.CJIS
Criminal Offender Record Information (CORI)

Acknowledgement Form

To be used by organizations conducting CORI checks for employment, volunteer, subcontractor, licensing, and housing purposes.

Somerville-Cambridge Elder Services, Inc is registered under the provisions of M.G.L c.6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, current licensees, and applicants for the rental or lease of housing.

As a prospective or current employee, subcontractor, volunteer, license applicant, current licensee, or applicant for the rental or lease of housing, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to Somerville-Cambridge Elder Services, Inc. to submit a CORI check for my information to teh DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing Somerville-Cambridge Elder Services, Inc. with written notice of my intent to withdraw consent to a CORI check.

FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY:

Somerville-Cambridge Elder Services, Inc. may conduct subsequent CORI checks within one year of the date this Form was signed by me, provided, however, that Somerville-Cambridge Elder Services, Inc., must first provide me with written notice of this check.

By signing below, I provide my consent to a CORI check and affirm that the information provided on Page 2 of this Acknowledgement Form is true and accurate.
Signature of CORI Subject
Date

MonthDayYear

THE COMMONWEALTH OF MASSACHUSETTS

EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY

Department of Criminal Justice Information Services

200 Arlington Street, Suite 2200, Chelsea, MA 02150

TEL: (617) 660-4640/ TTY: (617) 660-4046/ FAX: (617) 660-5973

MASS.GOV.CJIS
SUBJECT INFORMATION

Please complete this section using the information of the person whose CORI you are requesting. The fields marked with an asterisk (*) are required fields.
Name

First NameMiddle NameLast NameSuffix
Former last name(s), separated by commas:
Date of Birth

MonthDayYear
Place of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Last SIX digits of Social Security Number
If no Social Security Number, put zerosFormat: XXX -00-0000.
Sex:
Height
Format: 0 feet 00.0 inches.
Eye Color
Race
Driver's License or ID Number
State of Issue

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Father's Full Name
Mother's Full Name
Your Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Government-issued photo identification is required to run a CORI check!

Please supply one of the following: driver's license, state ID, passport, foreign passport with visa, U.S. military ID.
Please upload a PDF, PNG, or JPEG file of your ID. Please do not use photos with Apple's proprietary HEIC format.

Cancelof

Is there anything else you'd like us to know?
Click "Submit" to send your renewal and CORI forms.
Are you a Medical Escort volunteer who drives SCES consumers in your personal vehicle ? This is for the purpose of running a RMV driving report.
Should be Empty:

Thanksgiving Volunteer Application

Your Contact Info

Emergency Contact Info

We love volunteers with language skills!

Demographics

Other Volunteer Opportunities

Client Confidentiality Agreement

Delivery Event Volunteers

CORI form and Government-issued Identification:

Government-issued photo identification is required to run a CORI check!