• Volunteer Application Form

    Volunteer Application Form

    Our volunteers are at the core of Age Well Senior Services, and we are incredibly grateful to be a part of such a generous, dedicated, thoughtful community. Sign up to volunteer with our various programs below: Deliver Meals on Wheels or serve lunch at Senior Centers across Orange County.

  • *Important Note for Applicants*

    For the best experience, we recommend completing this form on a laptop or desktop computer.Once your application is successfully submitted, a "Thank You!" screen will appear, and you will receive a confirmation email. If you do not see these, your application may still be in process. If you need to step away, keep an eye out for a "Weekly Reminder" email to help you finish your form.
  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Which opportunity or opportunities you are interested in? Please check all that apply. Please note, our Lunch Program and Meals on Wheels opportunities are Monday-Friday during the morning and lunch hours (10AM -1PM).*

  • *If you are interested in the Friendly Visitor Volunteer opportunites, please use the link below to fill out the application specific to these programs:

    https://www.jotform.com/form/233046170482148

    *If you are interested in the Internship opportunites, please use the link below to fill out the Internship application:

    https://form.jotform.com/agewellvolunteer/internship-application

  • What city or cities are you available to volunteer in? Please check all that apply*
  • Must be to 18 years or older to volunteer without a parent or guardian*

  • Emergency Contact Information

  • Clubs & Employment

  • Do you belong to any club/committee/organization? Please select yes if you belong to an NCL Chapter*
  • Are you currently employed?*
  • Does your employer participate in a volunteer program?*
  • Are you or the company willing to participate in peer-to-peer campaigns?*

  • Availability & Skills

    Please note, our Lunch Program and Meals on Wheels opportunities are Monday-Friday during the morning and lunch hours (10AM -1PM)
  • Rows
  • Do you speak a second language other than English?*

  • Medical & History

  • If applicable, are you under any course of treatment/medication, which might limit your ability to perform certain types of work such as driving or handling any type of equipment?*
  • Have you ever been convicted, sentenced, placed on probation, pleaded guilty or “no contest” or agreed to deferred adjudication involving any crime related to illegal drugs, theft, fraud, or violence (e.g. Assault, battery, etc.)?*
  • Are you seeking credit/verification for your volunteer hours (school; non-court appointed)?*
  • Have you ever been convicted of found guilty of driving under the influence (DUI) or driving while intoxicated (DWI)?*
  • Has your drivers’ license ever been suspended or revoked?*
  • Are you seeking volunteer court-appointed hours?*

  • Background Check Requirement

    In the safe keeping of our seniors and community, a background check is mandatory to be an Age Well Volunteer for those volunteers +18 years and over

    You will be receiving a separate email from Sterling Volunteers (TheAdvocates@sterlingvolunteers.com) on behalf of Age Well Senior Services to complete the background check online. Please check your SPAM/Junk Folder in case you miss the email. 

    Age Well is a 501 (C) (3) nonprofit organization. The $19.00 cost of the background check is covered by Age Well. If you would like to offset any portion of this cost, we greatly appreciate your support. A contribution is not required to be a volunteer. This may be tax deductible, please check with your tax advisor.

  • Do you authorize Age Well Senior Services to complete a Volunteer Background Screening?*

  • For more information about the Sterling Volunteers background check, please use the link below:

    https://www.sterlingvolunteers.com/about/faqs/

    *The City of Dana Point requires a Live Scan background check. If you are a current Dana Point volunteer, we will reconfirm you have completed the Live Scan.

  • Confidentiality Statement

    Please initial

  • Conflict of Interest Disclosure

  • Please describe below any relationships, transactions, positions, you hold (volunteer or otherwise) or circumstances that you believe could contribute to a conflict of interest between Age Well Senior Services, Inc., and your personal interests, financial or otherwise.*

  • Hold Harmless and Release of Liability Agreement

    Please initial

  • Elder Abuse

    Please initial

  • Guests (Anyone accompanying a volunteer that has not completed a volunteer application)

    I will be held responsible for guest(s) that accompany me and I understand that I will be held responsible for their adherence to the above policies.
  • Agree or Disagree*

  • Children (anyone under 18 years)

    If I choose to take children with me on a Meals-on-Wheels route, I will be responsible for their behavior and their safety.
  • Agree or Disagree*

  • Pets

    No animals are allowed in the car when delivering Meals-on-Wheels. Exception only for ADA approved service dog.
  • Agree or Disagree*

  • Volunteer Commitment

    It has been explained that I have certain responsibilities as a volunteer and will as such make commitments to the program(s) for which I am volunteering. If I am unable to fulfill a commitment, I will notify my supervisor as soon as possible so that a suitable replacement can be found.
  • Agree or Disagree*

  • Photo & Media Release

  • I __do__do not grant permission to Age Well Senior Services, Inc. to use my image (including, but not limited to, photos and video in social media platforms such as Facebook and Instagram and the Age Well website.*

  • Email Release

  • I __do__do not grant permission to Age Well Senior Services, Inc. to send emails to the email address on file.*

  • VOLUNTEER PROGRAM CODE OF CONDUCT

  • Thank you for volunteering for Age Well Senior Services, Inc. We could not serve as many seniors without your help. Please read and abide by this Code of Conduct to avoid any situations that comprise the integrity, independence, and reputation of Age Well Senior Services, Inc. It is presumed that this Code of Conduct will be in addition to your good judgment since we cannot contemplate all possible situations of actual or potential conflicts of interest. All Age Well Senior Services, Inc., volunteers must adhere to the following:

    1. A volunteer may not accept personal gifts or gratuities from a client or participant.
    2. Volunteers must maintain the confidentiality and privacy standards of Age Well Senior Services, Inc. A volunteer may not distribute/share/disclose/reuse client information, addresses, or contact outside AWSS.
    3. Volunteers agree to participate in scheduled training.
    4. Volunteers agree to wear appropriate clothes when volunteering and closed toed shoes when working in the kitchen.
    5. Volunteers must work in support of their supervisor and abide by program regulations.
    6. Age Well Senior Services, Inc., is a smoke free and drug free work environment.
    7. Volunteers may be dismissed for reasons related to disrespectful conduct towards seniors,volunteers or staff.

  • Volunteer Documentation - Upload

    Required if volunteering to drive for Meals on Wheels
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  • Driver's License Expiration Date
     / /
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  • Insurance Expiration Date
     - -
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  • Registration Expiration Date
     - -

  • Volunteer Training & Documentation

  • For Meals on Wheels Drivers (REQUIRED)

    Please watch the Meals on Wheels training video. 

  • Click here if video is not loading : Meals on Wheels Training Video

  • For All Volunteers (REQUIRED)

    Emergency Situations 

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  • I have read and reviewed the above training document*

  • CDA Information Security Awareness Training

    As a new volunteer, we are required to provide CDA Information Security Awareness Training to all Age Well Staff and volunteers. You are required to complete this training and return your signed certificate within 30-days of your first volunteer shift.

    CDA Information Security Awareness Training:

    1. Go to the following link: https://www.aging.ca.gov/Information_security/
    2. Go to the bottom of the page where you will find an English and Spanish version. Click the version you prefer and complete the training.
    3. Save a copy of the certificate produced upon successful completion of the training (you must print and sign this certificate).
    4. Immediately send a copy of your signed certificate to volunteer@myagewell.org using “Security Awareness Training - (YOUR NAME)” in subject line.
    5. Return the original certificate to the Age Well Manager at your site by the deadline.

    If you have already completed the CDA Information Security Awareness Training within the last 30-days, please let me know and we can verify if we have your certificate on file.

    Thank you.

  • Complete Application

    I certify that all answers given by me on this application or any other accompanying or required documents are true, accurate and complete. The falsification, misrepresentation or omission of facts will be cause for denial or removal of my volunteer application/status, regardless of when or how discovered. Volunteer Placement is subject to the availability and discretion of the Agency.
  • Today's Date
     - -

  • Parent/Guardian Consent

    If volunteer is less than 18 years of age

  • Volunteers under 18 who are not accompanied by a parent or legal guardian are required to complete this section of the application. Without it, the minor will not be able to volunteer.

    A parent or legal guardian of each minor must read and agree to the following:

    By completing this form, I the parent or legal guardian of the named below, consent to the child’s participation in the volunteer activities organized by Age Well Senior Services. I understand that the child will be provided with orientation and training necessary for the safe and responsible performance of the volunteer duties and will be expected to meet all requirements of the position, including compliance with Age Well's policies and procedures.

    I understand that my child will receive no monetary compensation for this work.

  • Format: (000) 000-0000.
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