EmailMe Form - Transitions LifeCare - Volunteer Application

Transitions LifeCare - Volunteer Application

Transitions LifeCare does not discriminate in their selection of volunteers, hiring or employment on the basis of race, color, sex, disability, national origin, citizenship, or on the basis of age with respect to persons 18 years or older. No question on this application is intended to secure information to be used for such discrimination. Transitions LifeCare will hold you responsible for the accuracy of the statements you make on this application. Incomplete applications will not be considered.

Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone (home) *
### - ### - ####
Phone (cell)
### - ### - ####
Phone (work)
### - ### - ####
May we call you at work?
Yes
No
Email *
How do you prefer to be contacted? *
Phone
Email
Are you 18 years or older? *
Yes
No
How did you learn about volunteer opportunities at Transitions LifeCare? *
What volunteer opportunities are you interested in? (check all that apply)
Patient & Family Support
Administrative/Office
Specialty-We Honor Veterans
Specialty-Musical Presence
Specialty-Massage
Specialty-Pet Partner
Specialty-Vigil Support
Other
What days & times are you available to volunteer? *
Have you been impacted by a personal loss in the past 12 months? *
Yes
No
Was the person (spouse, domestic partner, child, parent, mother/father-in-law, sibling, daughter/son-in-law, or legal dependent/guardian) served by Transitions LifeCare? *
Yes
No
Special skills (check all that apply)
computer
writing
fundraising
arts/crafts
other
Please list languages you speak fluently
Volunteer/Employment history, most recent first

Agency/Employer (include position and years of employment)

Agency/Employer (include position and years of employment)

Agency/Employer (include position and years of employment)
Community recommendations (reference forms will be sent to the names provided. Please provide either a mailing address including zip code or an email address, and phone number for each reference) *

Name, Mailing or Email address, Phone

Name, Mailing or Email address, Phone

Name, Mailing or Email address, Phone
I have registered for a Volunteer Information Session. *
yes
no
I certify that the answers given herein are true and complete to the best of my knowledge (type name and date in box). *

Agency/Employer (include position and years of employment)
Agency/Employer (include position and years of employment)
Agency/Employer (include position and years of employment)

Name, Mailing or Email address, Phone
Name, Mailing or Email address, Phone
Name, Mailing or Email address, Phone