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Life Enrichment Volunteer Forms

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kiratnls
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20 views

Life Enrichment Volunteer Forms

Uploaded by

kiratnls
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Volunteer Application

Name: _____________________________________ Date of Application: _______________


Address: ____________________________________________________________________
City: ___________________________________ State: __________ Zip Code: __________
Education: ___________________________________________________________________
Occupation: _______________________ Employer/School:___________________________
Phone: Home __________________________ Work __________________________
Fax ____________________________ E-mail _________________________
Emergency Contact Name ______________________________ Phone _________________
____________________________________________________________________________
Have you been convicted of a felony within the past five years?  Yes  No
If YES, please explain ________________________________________________________
Tell us about your volunteer experience ____________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
When are you able to volunteer?
Time of day ________ Day(s) of week________ How often per month? ________
What interests, skills, training, or knowledge do you wish to share with the residents?
____________________________________________________________________________
____________________________________________________________________________
What training, resources, or support do you anticipate needing to do volunteer work?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I hereby attest that the above information is true to the best of my knowledge and
consent to a reference and criminal background check.

Signature _________________________________________________

Please provide two personal or professional references:

Name Phone Number Relationship

1. __________________________________________________________________________________

2. __________________________________________________________________________________
• Assist women residents in applying make-up, finger nail polish, and with
hair styling.
• Assist residents in accomplishing minor clothes repair, such as sewing on
buttons
• Assist in gardening or horticulture programs
• Assist in preparing displays of handi-crafts
• Assist in preparation of special events, such as parties for birthdays,
Christmas, Valentine’s Day, Fourth of July, Thanksgiving, etc.
• Participate in various types of fairs, such as crafts, etc.
• Assist in organizing and participate in community events, such as talent
shows, Senior Olympics, etc.
•
PHYSICAL DEMANDS
• Sitting 2-3 hours per shift with frequently getting up and down
requirements
• Walking 3 hours per shift
• Standing 2- 4 hours per shift
• Lifting 1-20# frequently, 21-35# occasionally, 36-709# rarely
• Bending, reaching, squatting and kneeling, crawling and climbing
• Using telephone

WORK ENVIRONMENT

Office, activities room, arts and crafts room, resident’s rooms, and throughout
the community.

ACCEPTANCE STATEMENT:

I have carefully read, understand, and accept the job description, including
the qualifications requirements of the position of Volunteer, if approved, I
certify that I can and will perform the essential functions of the position.

I understand the Universal Precautions Risk Classification Categories may


apply to this position and I may be exposed to AIDS, HIV, and Hepatitis B
viruses.

I further understand this community is of an “at will” nature, which means that
I may resign at any time and may be released at any time with or without
cause.

________________________________________________________________
________
Signature of Applicant Date

________________________________________________________________
________
Signature of Witness Date

Volunteer 2

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