Volunteer If you would like to volunteer, as a driver, organizer, board member or anything else, please fill out and submit the form below and a friendly member of our staff will get in touch with you shortly. Personal Information First Name Middle Name Last Name Phone Cell Prefer Home# or Cell#? Prefer Home Cell Address City Zip County Neighborhood Email Date of Birth Ethnicity Occupation/Employer (if retired, please list previous employer) Retired? Retired? Yes No Congregation affiliation (if any)_ How did you hear about Drive a Senior Northwest (Faith in Action) and why do you want to volunteer? What are you looking for in a volunteer opportunity? Please check any volunteer option(s) that may interest you. Please check any volunteer option(s) that may interest you. driver friendly calls events/fundraisers yard work help in office board member or committee member minor home repairs Senior Day Out driver (2nd and 4th Thursdays of each month, 10:00am-12:15pm) other: I can volunteer with the following parameters: I can volunteer with the following parameters: My schedule varies Only on certain days/times I am only available evenings and weekends I am available both weekdays and weekends How do you prefer to be assigned to drives? Please select ONE: How do you prefer to be assigned to drives? Please select ONE: I will use the online system, and I also don't mind being called to see if I am available I will use the online system only. Please do not call me. I do not use email and wish only to be called. General volunteer experience, languages, and hobbies Answer the next 3 questions if you plan to volunteer as a driver: What type of car do you drive? What type of car do you drive? Will anyone else be with you in the car? Will anyone else be with you in the car? We serve people who live in Northwest Austin, Cedar Park, and Leander. Do you have any limitations on the distance you would drive for volunteer work? We serve people who live in Northwest Austin, Cedar Park, and Leander. Do you have any limitations on the distance you would drive for volunteer work? Emergency Contact Name Phone Relationship Address of emergency contact if different: References (Please list two). Name Phone Relationship Name Phone Relationship I confirm that all of the above information is true and correct to the best of my knowledge. I give my consent for Drive a Senior Northwest to contact my references. I understand that a criminal background check ( and for volunteer drivers - a driving record check ) will be conducted. If volunteering to drive, I agree that I am responsible for maintaining a valid driver's license & current liability insurance on my vehicle and am obligated to notify Drive a Senior Northwest of change in status of either. Signature of Applicant Date Send
