Volunteer Application

Full Name

Date

Address (Street, City, State, Zip)

Date of Birth

Date

Phone Number

Email

example@example.com

Social Security Number

What opportunity are you volunteering for:

What experience (if any) do you have in this field?

What days are you available? (check all that apply)

What time(s) are you available? (for example: weekends only/ mornings only/ after 5pm/ etc.)

Highest level of Education

Are you currently employed?

YesNo

If so where?

Have you ever been employed by CAAC or any other area Agency on Aging?

YesNo

If so where?

Name

Relationship

Please list 3 Personal/ Professional References (non-relatives):

1. Name

1. Phone

2. Name

2. Phone

3. Name

3. Phone

All applicants must answer the following question. Failure to answer honestly will disqualify the volunteer from service. CAAC does conduct background checks on all volunteers and employees.

Have you even been convicted of a felony or misdemeanor?

YesNo

If yes, please describe the conviction. Please include the date, city and state in which the crime occurred.

Certification Authorization and Release: I certify that all information on this Application is accurate, complete and true to the best of my knowledge. I understand that providing any false, inaccurate, incomplete or misleading information may result in my disqualification from consideration for volunteering with Central Alabama Aging Consortium.

I authorize CAAC to investigate the accuracy and truthfulness of all information provided on this Volunteer Application and to contact listed references and any other person who can verify information provided on this Application. I authorize all persons involved in the onboarding process to discuss and review the results of any such investigation or contacts. I further authorize all contacted persons to provide to CAAC information concerning this Application, my background and my suitability for volunteer services.

By signing below, I release from liability each person, employer, agency or organization who or which provides any information regarding me, or my previous employment, education or work experience and I further release CAAC and its directors, officers, employees and agents from liability for any use or disclosure, for purposes related to consideration of my Application for volunteering with CAAC, of any information obtained related to my Application.

If selected, I will conform to the rules and regulations of CAAC.

Print Name

Signature

Date

Volunteer Application

Contact Information

Volunteer Position Information

Emergency Contact Information