Adult Volunteer Application

I am at least 21 years old.

Yes

I will provide my Driver's License Number and Social Security Number to the President of GVSS for the purpose of passing a background check.

Yes

First Name

Last Name

Date of Birth

Gender

Male Female

Address

City

Zip Code

Home Phone Number

Cell Phone Number

Best way to reach me:

Text Email Phone Call

Are you employed?

Full-time Part-time Not employed Retired

Emergency Contact First & Last Name

Emergency Contact Phone Number

Emergency Contact Relationship

Please list organizations where you currently or previously have volunteered:

If you plan to drive, what type of vehicle do you drive:

SUV Pickup Truck Sedan Minivan

Please indicate below when you ARE available to volunteer:

Monday

Morning Afternoon Evening

Tuesday

Morning Afternoon Evening

Wednesday

Morning Afternoon Evening

Thursday

Morning Afternoon Evening

Friday

Morning Afternoon Evening

Saturday

Morning Afternoon Evening

Sunday

Morning Afternoon Evening

Please list 3 references, one of which should be volunteer/work related:

Reference #1 Information:

First & Last Name

Phone Number

Relationship

Reference #2 Information:

First & Last Name

Phone Number

Relationship

Reference #3 Information:

First & Last Name

Phone Number

Relationship

Please acknowledge the following:

I certify that the answers and information provided in this Volunteer Application are accurate and complete to the best of my knowledge. I acknowledge that if any of the information provided is not accurate or complete, I may be denied the opportunity to provide volunteer service.

Yes

I authorize GVSS to investigate all statements contained in this application for volunteer service, as well as my character and qualifications. I release GVSS from all liability for acts performed in good faith in connection with said investigation and evaluation of my application.

Yes

I understand and agree that I am not employed by Grimes Volunteer Support Services and that the relationship between GVSS and me may be terminated at any time by either party.

Yes

I understand and agree that as a volunteer I must conform to all GVSS rules and regulations.

Yes

I understand that information I have provided on my volunteer application is confidential. I also understand and agree that information I obtain or learn while assisting a client shall remain confidential.

Yes

I understand and agree that if I will be driving clients, I must provide a copy of my current driver's license and auto insurance coverage to Grimes Volunteer Support Services. I further understand and agree to provide updated copies of my license and insurance coverage each year I am a volunteer driver.
Yes

I understand that as a volunteer, I am not allowed to receive any payment, tips, or reimbursement for any service provided to a client.
Yes

I hereby certify that I DO NOT have a record of founded child and/or dependent adult abuse.
Yes

I understand that one of my responsibilities is to report my hours and miles within three days of providing a service to the GVSS office by phone or email.
Yes

I hereby give GVSS permission to take photographs, videotapes, or digital recordings of me to be used in promoting their service in the community. I understand there will be no financial or other reimbursement for recording me, either initial or subsequent transmission or playback.

I agree and understand that by typing my first and last name below, I am providing my electronic signature on this document, and it is the legal equivalent of my manual/handwritten signature. I consent to be legally bound by this agreement.

Fill Out Your Adult Volunteer Application Here!

Fill Out Your
Adult Volunteer Application
Here!