Volunteer Application | Crawford County Commission on Aging

Personal Information
Gender*
Name*
First Middle Last
Address*
Street Address City State ZIP Code
Mailing Address (if different)
Street Address City State ZIP Code
County*
Township*
Home Phone*
Cell Phone*
Email*
Birth date*
MM slash DD slash YYYY
Race*
- White
- Black
- Hispanic
- American Indian or Alaska Native
- Asian or Pacific Islander
- Other/Unknown
Provide any other name(s) previously used (include aliases, maiden, married or N/A):*
Emergency Contact Information
Name*
First Last
Phone*
Relationship*
Availability
How often would you like to volunteer*
- Daily
- Weekly
- Monthly
Are you available on Mondays?*
- Yes
- No
What time of day are you available on Mondays? (check all that apply)*
- Mornings
- Afternoons
- Evenings
Please enter the time you are available on Monday Mornings (HH:MM - HH:MM)
Please enter the time you are available on Monday Afternoons (HH:MM - HH:MM)
UntitledPlease enter the time you are available on Monday Evenings (HH:MM - HH:MM)
Are you available on Tuesdays?*
- Yes
- No
What time of day are you available on Tuesdays? (check all that apply)*
- Mornings
- Afternoon
- Evening
Please enter the time you are available on Tuesday Mornings (HH:MM - HH:MM)
Please enter the time you are available on Tuesday Afternoons (HH:MM - HH:MM)
Please enter the time you are available on Tuesday Evenings (HH:MM - HH:MM)
Are you available on Wednesdays?*
- Yes
- No
What time of day are you available on Wednesdays? (check all that apply)
- Mornings
- Afternoons
- Evenings
Please enter the time you are available on Wednesday Mornings (HH:MM - HH:MM)
Please enter the time you are available on Wednesday Afternoons (HH:MM - HH:MM)
Please enter the time you are available on Wednesday Evenings (HH:MM - HH:MM)
Are you available on Thursdays?*
- Yes
- No
What time of day are you available on Thursdays? (check all that apply)
- Mornings
- Afternoons
- Evenings
Please enter the time you are available on Thursday Mornings (HH:MM - HH:MM)
Please enter the time you are available on Thursday Afternoons (HH:MM - HH:MM)
Please enter the time you are available on Thursday Evenings (HH:MM - HH:MM)
Are you available on Fridays?*
- Yes
- No
What time of day are you available on Fridays? (check all that apply)
- Mornings
- Afternooons
- Evenings
Please enter the time you are available on Friday Mornings (HH:MM - HH:MM)
Please enter the time you are available on Friday Afternoons (HH:MM - HH:MM)
Please enter the time you are available on Friday Evenings (HH:MM - HH:MM)
Community Service
Are you volunteering to fulfill a requirement for court-ordered community service?*
- Yes
- No
How many hours do you need to complete?
By what date?
MM slash DD slash YYYY
Students
Are you a student?*
- Yes
- No
Are you volunteering to fulfill a requirement for school?*
- Yes
- No
How many hours do you need to complete?
By what date?
MM slash DD slash YYYY
Employment History:
Name of current/most recent employer*
Job title and responsibilities*
Address of Company You Work For*
Street Address City State ZIP Code
Phone Number of Company You Work For*
Supervisor's Name*
First Last
May we contact this employer?*
- Yes
- No
Name of previous employer
Job title and responsibilities
Address of Previous Employer
Street Address City State ZIP Code
Phone Number of Previous Employer
Previous Employer Supervisor's Name
First Last
May we contact your previous employer?
- Yes
- No
Volunteer History
Name of current/most recent organization/agency*
Volunteer role and responsibilities*
Address*
Street Address City State ZIP Code
Phone*
Supervisor's Name*
First Last
May we contact this organization?*
- Yes
- No
Name of previous organization/agency
Volunteer role and responsibilities at previous organization/agency
Address of previous organization/agency
Street Address City State ZIP Code
Phone of previous organization/agency
Previous Organization/Agency Supervisor's Name
First Last
May we contact this previous organization/agency?
- Yes
- No
Education and Training
Do you have any specialized education or training beyond high school (e.g. professional licenses, technical training, etc.)?
References (excluding relatives)
Reference #1 Name*
First Last
Reference #1 Phone*
Reference #2 Name*
First Last
Reference #2 Phone*
Reference #3 Name*
First Last
Reference #3 Phone*
Driver Information
Do you have a valid driver’s license?*
- Yes
- No
Do you have valid car insurance?*
- Yes
- No
Abilities
Do you require reasonable accommodations in order to perform volunteer services?
- Yes
- No
Please explain
Can you lift up to 25lbs?*
- Yes
- No
Talents & Interests Survey
This information will help us get to know you and how you can serve our community better. Participating in this survey does not commit you to a specific role, but helps us to match you to a volunteer opportunity.
My talents and interests are (check all that apply):*
- arts and crafts
- athletics and sports
- building and construction
- cleaning and organizing
- clerical work
- communicating
- computers and technology
- cooking
- dancing
- drama
- driving and transportation
- event planning
- exercise and personal health
- facilitating groups
- financial (taxes, insurance, etc.)
- fundraising
- gardening & composting
- listening and discussing
- maintaining building and grounds
- marketing and public relations
- mentoring
- music
- photography
- playing an instrument
- public speaking
- recruiting others
- reading
- sewing
- serving food
- social justice & advocacy
- singing
- teaching
- telephoning
- visiting others
- welcoming and hospitality
- woodworking
- working with children
- working with veterans
- writing
- other
What instrument(s) do you play?
Please list talents or abilities you have that are not listed above:
I would prefer volunteer work that allows me to work in the following contexts:*
- alone
- with one or two other people
- as part of a small group
- as part of a large group
- as a leader
At this time, I would prefer to explore volunteer opportunities that require*
- monthly commitments
- weekly commitments
- daily commitments
I am a snowbird and winter away from Grayling.*
- Yes
- No
I want to volunteer because:*
Permission
I give permission for Crawford County Commission on Aging to contact references and conduct a criminal record check. I understand that such reports may be obtained annually during my volunteer service*
- Yes
- No
I authorize the use of my name and photographs/videos for publicity purposes.*
- Yes
- No
Are you a minor (under 18 year of age)?*
- Yes
- No
For parents of minors, please review the information filled out in this application and type your name believe to certify all information is true and correct to the best of your knowledge.*
Authorization*
- By checking this box, I hereby certify all information is true and correct to the best of my knowledge.
Name
This field is for validation purposes and should be left unchanged.

Personal Information

Emergency Contact Information

Availability

Community Service

Students

Employment History:

Volunteer History

Education and Training

References (excluding relatives)

Driver Information

Abilities

Talents & Interests Survey

Permission