Pickens County Meals on Wheels

Volunteer Application

Applicant Name: *
Address: *
Home Phone: *
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Mobile Phone: *
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Work Phone:
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E-mail: *
Date of Birth: *
 /  / 
Gender: *
Employer: *
Church Affiliation: *
How did you hear about PCMOW? *

What day(s) are you available for volunteering? *
Which area(s) are you interested in volunteering? *

Please List Two References
First Reference Name: *
First Reference Phone: *
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Second Reference Name: *
Second Reference Phone: *
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Special Skills or Qualifications
List special skills and qualifications you have acquired including hobbies or sports that you would be willing to share:

Previous Volunteer Experience
Summarize your previous volunteer experience. *

Have you had a DUI or DWI within the last ten years: *


Emergency Contact Information
Emergency Contact:
Relationship:
Emergency Contact Home Phone: *
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Emergency Contact Mobile Phone: *
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Emergency Contact Work Phone: *
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Emergency Contact E-mail:

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.


Consent - Photographic 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.

I Consent: *

Agreement

By electroinically 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.

Furthermore, I grant permission to share my contact information

with other Pickens County Meals on Wheels volunteers

for the sole purpose of matters relating to Pickens County

Meals on wheels.