Valleyview Volunteer Application Form

Valleyview Volunteer Application Form

Policy No. Vol. 1-110B

We would like to know more about you.  Please answer the following questions.  If some questions do not apply to you, please leave them blank.

  1. Name:
  1. Address:  Postal Code:  
  1. Telephone:  Residence:    Business:  
  1. Email:  
  1. School you attend (if applicable):  
  1. What type of volunteer activities would you like to do?  (For Example: do you wish to visit residents one to one, assist with and escort residents to recreational and social programs, work in the hairdressing shop, accompany residents on outings and at special events, administrative duties, etc.)

  1. Why do you want to be a volunteer at Valleyview Home?

  1. List any training, experience and/or special interests you have in gerontology or working with seniors.

  1. List any other training or areas of expertise you may have that would help you as a volunteer with Valleyview Home.

10.  When would you (generally) be available for volunteer service?  Please check all that apply

TimesMondayTuesdayWednesdayThursdayFridaySaturdaySunday
Morning
Afternoon
Evening

 

  1. How much time would you have available to do volunteer work at Valleyview?  (Ex. 2 hours per week, 4 hours per month, etc)

  1. Describe any previous volunteer experience that you have had.

  1. Is there any other information that you would like to tell us that relates to you becoming a volunteer with Valleyview?

  1. The Volunterr Policies and Procedures for Valleyview require that a Police Records Check (Vulnerable Screenin) be on file for all volunteers.  Do you agree to go to your local Police Department to have this check conducted?

Yes            No 

Date:  

 

Volunteer Character References

Policy No. Vol. 1-110C

Please list 2 (two) character references who we may contact on your behalf.  They will either be contacted by telephone or, a small questionnaire in a self addressed, stamped envelope will be mailed to them.  It is preferred that you do not list family members as references.

Reference #1

Name:  

Mailing Address:  

City:    Postal Code:  

Phone:  (Home)     (Work)  

Reference #2

Name:  

Mailing Address:  

City:    Postal Code:  

Phone:  (Home)     (Work)  

 



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