St. Anthony Park Area Seniors

2200 Hillside Avenue

St. Paul, MN 55108

office@SAPASeniors.org

www.SAPASeniors.org

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.

 

  1. _________________________________________________________________
  2. _________________________________________________________________
  3. _________________________________________________________________
  4. _________________________________________________________________

 

** 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 ___

 

 

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.