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Volunteer Application

Contact Information
Phone Type
Employment History
Are you currently employed?
Previous Volunteer Experience
Do you have experience working with older adults?
References (List 2):
Education (Check highest level)
Skills (Check all that apply)
I am interested in volunteering:
Please list hours you are available on your preferred days.
Are you a Student?
I am interested in a specific program
For Senior Connections Volunteers
Please check what you would be willing to do when you visit
For Drivers

For volunteers who wish to be drivers, a valid driver’s license and proof of current insurance must be submitted to SASI and or Senior Connections.

In signing this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission, or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize Services for Adults Staying in Their Homes, to which I am applying, to conduct any investigation necessary concerning any part of my background related to the position I am seeking, including, but not limited to, the obtaining of a criminal background check. I authorize any of the persons or organizations named in this application to provide complete information and records regarding my employment, education, character and qualifications. I release all parties from any liability in connection with the provision and use of such information.

I have read and agree with the above.
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