Volunteer Application Form

Date: MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay12345678910111213141516171819202122232425262728293031Year2010200920082007 Name:   Address:       Town: State: Zip:   Phone:   Birthdate: MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay12345678910111213141516171819202122232425262728293031Year20042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904   E-mail: 1. Do you have previous volunteer experience?   Yes:   No:               If yes, describe:           2. Please tell us about your background:                     Skills:               Hobbies:               Work History:           3. How would you like to volunteer at the center?                    Home Delivered Meal Driver  Receptionist                  Driver/Escort  Dining Room Greeter                  Dining Room Hostess/Host  Wait Staff                  Craft Shop Attendant  Teaching/Sharing Crafts                  Telephone Caller  Fund Raiser                  Other             4. How often would you like to volunteer?             5. Do you have your own transportation and insurance? Yes:   No:             6. Person to notify in case of emergency?               Phone: (Please include area code.)             7. Please list the names and phone numbers of three references:               1. Name:   Phone:               2. Name:   Phone:               3. Name:   Phone:             If you have any questions, ideas, or suggestions, please feel free to enter them in the field below or contact the Bugbee Senior Center at 295-9068.