St. Anthony Park Area Seniors
2200 Hillside Avenue
St. Paul, MN 55108
651-642-9052
Volunteer Application
Name: ________________________________________Today’s Date ______________
First name Middle name Last name
Address: ________________________________________________________________
Permanent Address _______________________________________________________
Previous Addresses (in last seven years): ________________________________________________________________________
________________________________________________________________________
Previous Names (like maiden name, other married names);________________________
_______________________________________________________________________
Phone: (Home) _____________ (Work) _________________ (Cell) ______________
Email: __________________________________________________________________
Birth date: _______________________
Experience
Please list paid and/or volunteer positions. Indicate with a * position(s) in which you are currently working. Attach additional information if desired.
- _________________________________________________________________
- _________________________________________________________________
- _________________________________________________________________
- _________________________________________________________________
** Have you ever been convicted of a felony? [ ] yes [ ] no
** Have you ever been convicted of a misdemeanor: [ ] yes [ ] no
If checked yes, please explain: ____________________________________________
Education
High School __________________________________________________________
College or University ____________________________________________________________________
Special Training or Skills _______________________________________________
Areas of Volunteer Interest
Please circle your areas of interest.
Visitor Home helper Event organizing
Provide transportation Office mailings Computer assistance
Board member Committee member Caregiver respite visitor
Dog walker Fundraising Blood pressure checks
Run errands Wash windows Handyman skills
Do laundry
Meals on Wheels driver Exercise class leader (substitute) “Dream grantor”
Seasonal chores (raking, snow removal, lawn mowing)
Other, specify ______________________________
Availability
Days of the Week _____________________________________________________
Time of Day _________________________________________________________
Can you make a six-month commitment to our program? [ ] yes [ ] no
If no, how long are you able to commit to volunteering? _______________________
If matched with a senior citizen as a friendly visitor, are you able to commit to making contact with the senior once very two weeks?
(Contact includes phone calls, mailings, and personal visits.)
[ ] yes [ ] no Comments_________________________________________________
_____________________________________________________________________
What type of activities do you enjoy doing for fun or leisure?
____________________________________________________________________
____________________________________________________________________
Are you fully vaccinated for Covid-19? Yes ___ No ___
Are you fully vaccinated for the Flu? Yes____ No ____
If you will be using your car for your volunteer work, please complete:
Driver’s License Number:__________________ Expiration date: _______________
Auto Insurance Company: ______________________________________________
Policy Number: __________________ Expiration date: ______________________
Is your driving record free and clear? [ ] yes [ ] no
If no, please explain: ______________________________________________
_______________________________________________________________
I attest that the above information is true and accurate and that St. Anthony Park Area Seniors is not responsible for any personal injury or auto damage incurred while volunteering.
________________________________________ ______________
Signature Date
How this Information is Used
We need the above information to help us to keep track of our volunteers. This information, as well as the hours that you report as a volunteer, helps us to secure the funds that we need through the government and private grants. We will also use the information provided in this application to check public databases for past criminal activity. If something comes up, it does not necessarily mean that you will be disqualified. We want to make appropriate assignments for our volunteers and our senior participants.
We assure you that we never give out any personal information without the volunteer’s permission. We keep all volunteer personal paperwork in a locked office filing cabinet, which is only accessible to office staff. We shred any documents that are no longer needed that contain any personal information.