Required fields are marked with asterisks (*)

Meals on Wheels Volunteer Application Form

Name

Email:

Address:

Home Phone Number:

Cell Phone

Work Phone Number:

Emergency Contact:

Phone Number:

Volunteer Type

Individual

Corporate

Group

If corporate or group, please indicate affiliation

Type of role(s) preferred

Driver

Helper

Both

Availability:

Once a Month

Twice a month

3 or more times per month

As a spare

Days Available:

Monday

Tuesday

Wednesday

Thursday

Friday

Are you aware of any changes in your availability in the next year? (Away for the winter, planned vacations, etc)

In what languages can you communicate in verbally

English

French

Other

If other, please specify

Age Category (optional)

Under 18

18 - 35

36-50

51-65

I do not wish to disclose my age

Do you have past volunteer experience? If so, what were your duties?

References

I agree to have the following references (excluding family) whom I have known for at least one year, contacted by Meals on Wheels.

Name:

Phone Number:

Relationship:

Name:

Phone Number:

Relationship:

Criminal Reference Check and Vulnerable Sector Screen

Meals on Wheels requires all applicants to obtain a Criminal Reference Check and a Vulnerable Sector Screen. Applicants must agree to present themselves to the Cornwall Police Station for this procedure. The cost of $16.95 will be reimbursed to you upon receipt of the completed check.

Do you agree to this procedure?

Yes

How did you hear about Meals on Wheels?

Newspaper

Radio

Website

Poster

Facebook

Word of mouth

Other

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Meals on Wheels Volunteer Application Form