Applicant Name (First, Last) (required)
Applicant Phone (required)
Applicant Street Address (required)
City (required)
State (required)
Zip Code (required)
Home Phone (required)
Mobile Phone (required)
Work Phone (required)
Email (required)
Date of Birth (required)
Gender (required) MaleFemale
Employer: (required)
Church Affiliation: (required)
What day(s) are you available for volunteering? (required) MondayTuesdayWednesdayThursdayFriday
Which area(s) are you interested in volunteering? (required) Driver to Deliver foodKitchen HelpEvents/ActivitiesOffice/ClericalFundraisingSpecial ProjectsPhotographyScrapbooking
First Reference Name (First, Last) (required)
First Reference Phone (required)
First Reference Email (required)
Second Reference Name (First, Last) (required)
Second Reference Phone (required)
Second Reference Email (required)
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports that you would be willing to share: (required)
Previous Volunteer Experience
Summarize your previous volunteer experience: (required)
Drivers Only: Have you had a DUI or DWI within the last ten years? (required) YesNo
Drivers Only - Please attach a coy of your Driver's License:
Drivers Only - Please attach a coy of your Insurance Card:
Person to Notify in Case of Emergency
Emergency Contact (First, Last) (required)
Emergency Contact Street Address (required)
Emergency Contact City (required)
Emergency Contact State (required)
Emergency Contact Zip Code (required)
Emergency Contact Home Phone (required)
Emergency Contact Mobile Phone (required)
Emergency Contact Work Phone (required)
Emergency Contact Email (required)
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.
Photo Release
I hereby authorize Pickens County Meals on Wheels to release any photographs taken of me for any purpose related to the promotion and well-being of Pickens County Meals on Wheels including, but not limited to newspapers, magazines, presentations and television. (required)
YesNo
Agreement
By electronically submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my dismissal.
