Meals On Wheels Volunteer Application

Meals On Wheels Volunteer Application
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*
Format: (000) 000-0000.
Primary E-mail*

Confirmation Emailexample@example.com
Are you retired?
Employer
FORMER EMPLOYER IF RETIRED
Marital Status*
Name of spouse

First NameLast Name
What inspired you to volunteer for Meals On Wheels?*
NEWSPAPER, FRIEND, CHURCH, ETC..
Are you a part of a group?*
Please Specify*
MEALS DELIVERY DRIVERSUBSTITUTE DRIVER
MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY
YESNO
YESNO
YESNO
YESNO
If you answered yes to any of the above or if there is any fact or circumstances involving you or your background that would call into question your being entrusted as a Meals On Wheels volunteer, please explain.
I UNDERSTAND THAT FOR AMARILLO MEALS ON WHEELS TO PROTECT VULNERABLE CLIENTS THE FOLLOWING VERIFICATION AND CHECKS WILL BE CONDUCTED AS PART OF THE VOLUNTEER REGISTRATION PROCESS:
- DRIVER'S LICENSE
- CRIMINAL BACKGROUND HISTORY
I GIVE MY PERMISSION TO AMARILLO MEALS ON WHEELS TO PERFORM THESE REQUIRED CHECKS. I UNDERSTAND THAT THE INFORMATION PROVIDED BELOW WILL BE KEPT CONFIDENTIAL AND USED FOR THE SOLE PURPOSE OF VERIFYING IDENTIFICATION AND CHECKING REQUIRED RECORDS. ANY INFORMATION OBTAINED BY THE ORGANIZATION WILL ALSO BE STRICTLY CONFIDENTIAL.

If I dispute one of the above records, I will have an opportunity to request another review.
DISCLOSURE AND AUTHORIZATION-BACKGROUND INVESTIGATION
I agree to abide by the rules and regulations of Amarillo Meals on Wheels to the best of my ability.
I agree to respect the privacy and confidential nature of my personal contacts with clients, by not discussing or divulging names, addresses, and situations to anyone except the appropriate MOW staff.
I understand the importance of notifying Amarillo Meals on Wheels in advance if I cannot perform my volunteer job.
I agree to keep a CURRENT Driver's License, a valid inspection sticker, and up-to-date liability insurance coverage on my vehicle, as required by the Texas Department of Public Safety (drivers only)
By typing my name below I am agreeing to the following:

I will assume all risks, hereby release, hold harmless and forever waive any and all rights for claims or damages I may have against Amarillo Meals on Wheels and its sponsors, and all their respective officers, directors, contractors, managers, clients, employees, and volunteers of the organization for any and all injuries, losses, claims, damages, judgments, liabilities, actions or causes of action sustained by me as a result of my participating as an Amarillo Meals on Wheels volunteer or if conducting additional interactions with Amarillo MOW clients outside of my volunteer role.

Amarillo Meals on Wheels cares about your privacy. All volunteer information supplied will remain within our organization and will not be shared with any outside parties. Your personal information will not be sold, distributed, or published in any manner whatsoever.
VOLUNTEER FULL NAME*

Legal First NameLegal Middle NameLegal Last Name
Birthdate*

MonthDayYear
SSN*
Drivers License or State ID Number*
State ID was issued*
Name of Insurance Provider*
Today's Date*

MonthDayYear
By typing my name below, I am signing this application electronically. I agree that this electronic signature is the legal equivalant of my manual signature on this application.
Signature

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