1200 North Pleasant St
PO Box 9629
North Amherst, MA 01059
(413) 549-3968 x202 / For office use:
Interviewed by: ______
Date:______
Last day (if known) ______
Placement:______
Orientation ______
Handbook
VOLUNTEER APPLICATION
How did you hear about our volunteer program? ______
Are you associated with a special volunteer program (Community Service, DTA, CSL)? Yes __ No __ How many hours do you need to do? ______
Do you need us to keep track of your volunteer hours? Yes ____ No _____
What languages do you speak?______
Do you have any special skills, hobbies, or experience that may be useful in your work with ASC? i.e.- fundraising, computer skills, construction, graphic design, arts/crafts, cooking etc.
______
______
Do you have any special considerations, i.e. physical or medical, that we should be aware of? ______
[*]Have you ever been convicted of a crime? Yes____ No____
[*]Are there any criminal matters pending against you? Yes _____ No______
If yes, please explain: ______
Would you be willing to complete a form giving us permission to run a CORI check on you? Yes ______No ______
Please indicate any additional information that may be helpful to us ______
______
Reference:(preferably someone who works, or has worked, with you)
Name ______Phone ______
I certify that the statements made in this volunteer application are true and correct to the best of my knowledge.
I hereby authorize Amherst Survival Center to contact the reference given above as needed for volunteer placement.
I understand that as a volunteer I am required to attend a volunteer orientation and that I must abide by all rules and regulations of Amherst Survival Center. I also understand that I will not be paid for my services as a volunteer.
I agree to keep all information about Amherst Survival Center consumers in confidence. If there is a problem or an issue with an individual, I will only speak to ASC staff people to try and resolve it.
By recognizing the dignity and beauty of every person, I agree to help build and create our community as an Amherst Survival Center volunteer.
Signature of Applicant ______Date Signed______
Please complete so we can more easily assist you in finding a time and area to volunteer. Most volunteers commit to a 2-3 hours shift/week.
VOLUNTEER OPPORTUNITIES AVAILABLE
Community Kitchen: 9:00 AM to 1:30 PM and Thursday 5-7PM
Preparing and serving lunch, assisting with clean-up
Mon Tues Thurs Thurs PM Fri
Driving for Fresh Food Distribution: 9AM to 10:30AM
Picking up fresh bread and produce at local grocery stores and farms.
Mon Tues Thurs Thurs PM Fri
Fresh Food Distribution Program:9:30 AM to 12:00 PM
Unloading, organizing, distributing food items from delivery trucks
Mon Tues Thurs Fri
Emergency Pantry Program:10:30 AM to 3 PM and Thursdays 3-7 PM
Preparing and distributing grocery packages to clients
Mon Tues Thurs (11-3) Thurs (3-7) Fri
Free Store:11 AM to 3 PM and Thursdays 3 to 7 PM
Keep the store organized, cleaned and stocked. Sort donations of clothing and household goods for distribution in the free store.
Mon Tues Thurs (11-3) Thurs (3-7) Fri
Reception: 10:30 AM to 3 PM, Thursdays 3-7PM
Answer phones, greet and help visitors, screen and write receipts for donations, monitor the free store
Mon Tues Thurs Thurs PM Fri
Operations: 9AM to 4PM
Assist in doing maintenance jobs as needed.
Mon Tues Thurs Fri
Special Events:
Help at annual events like Trash to Treasures, the Toy Drive, Holiday meals, Chinese New Year, Black History Month, etc.
Yes which ones? ______
Family Night:
2 Mondays/month from 4:15-6:45 Yes
Please return completed application by mail, e-mail, or in person, to:
Tracey Levy, Amherst Survival Center, PO Box 9629, North Amherst MA 01059
Phone: 413-549-3968 x202 E-Mail:
THANK YOU!
[*] Applicants who indicate a conviction of a crime or pending criminal matters will not be summarily rejected.
[*]