Wallingford COMMUNITY Senior Center Volunteer Application(18 & Older)

Date: ______Driver's License # (if applicable) ______

Basic Information

Name: Date of Birth: ______

Address: City/State: ______Zip: ___

Telephone # 1: _____ Telephone # 2: ______

Email address: __Do you prefer to communicate via phone or email?______

Do you have any health restrictions, limitations or equipment that needs to be accommodated? Yes  No

If yes, please describe: ______

Emergency Contact Information

Name: Relation:______Telephone:______

Please check the following boxes that best describe you:

Currently Working. Employer & Job Title: ______

Looking for WorkRetired

Student (School) ______Other (Describe):______

Is your volunteer service court appointed? Yes  No

Which positions or areas are you interested in volunteering?

______

How many hours per week do you see yourself potentially volunteering? ______

During which times might you be available to volunteer?

 Weekday mornings  Weekday afternoons  Occasional weekday evenings  Occasional weekend days

What type of commitment are you looking for (i.e., one event, a short project, a longer project, ongoing, etc.)?

______

Why do you want to volunteer at Wallingford Community Senior Center and what do you hope to gain from your experience?

______

______

What skills and abilities would you like to use when volunteering at WCSC?

______

______

Have you had previous volunteer experience(s)? If yes, please describe below.  Yes  No

______

______

Have you worked with older adults in a volunteer/ employment capacity? If yes, pleasedescribe.  Yes  No

______

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How did you hear about Wallingford Community Senior Center?

______

Please describe your work or interests.

Please give the names and phone numbers for 2 references not related to you (one personal and one professional).

Name/Relationship: ______Phone Number: ______

Name/Relationship:______Phone Number:______

List Current/Past Employment: ______

______

Have you ever been convicted of a felony, sexually related crime, or an offense related to abuse of a child or a vulnerable adult?  Yes  No

If Yes, please describe the nature of the offense, the date, and jurisdiction where it occurred.

______

______

Where have you lived in the past 5 years?  Continuously in WA  Less than 5 years in WA  Out of WA

If you have not lived in Washington for the last five years, what states did you live in during the last five years?

______

Is your volunteer service court appointed? Yes  No

Background Check

As part of volunteer screening, WCSC conducts background and reference checks prior to accepting volunteers for service. By signing below, I voluntarily and knowingly allow WCSC to run background checks and reference checks as needed, and I waive the option to bringany legal action against Wallingford Community and Senior Center regarding the process and completion of a background check. I have reviewed my application and I attest that the information is true, accurate and complete to the best of my knowledge. All volunteers 18 and older must pass the background check.

Signature: ______Date:______

Please email your completed application & Washington State Patrol WATCH background check to ,or mail it to Volunteer Coordinator, Wallingford Community Senior Center, 4649 Sunnyside Ave. N., Suite 140, Seattle, WA 98103.

Thank you for completing this volunteer application. We look forward to talking with you.

All personal information will be kept confidential

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