STEP 1 OF 3

Volunteer Application

*Name:

State:

City:

Zip:

Street Address:

Home Phone:

E-mail:

*Phone:

Birth date:

STEP 2 OF 3

Availability

During which hours are you available for volunteer assignments?

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend mornings

Weekend afternoons

Weekend evenings

Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities,including hobbies or sports.

Previous Volunteer Experience

Summarize your previous volunteer experience.

STEP 3 OF 3

Person to Notify in Case of Emergency

*Name:

Street Address:

State:

City:

Zip:

*Phone:

Work Phone:

Email:

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Our Policy

It is the policy of Nutmeg Senior Rides, Inc.to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.Thank you for completing this application form and for your interest in volunteering with us.

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