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* 1. Date

Date

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* 2. Contact Information

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* 3. Preferred Method of Communication (check all that apply):

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* 4. Date of Birth

Date

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* 5. Why are you interested in volunteering with the Department of Older Adult Services?

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* 6. Education (Institutions, diplomas, certificates, degrees, etc.):

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* 7. Interests/Skills/Hobbies/Languages Spoken:

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* 8. Please tell us about your prior work or volunteer experience (roles, organization names, dates of service). We will reach out separately if we decide to pursue reference checks:

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* 9. Volunteer Interests (check all that apply):

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* 10. I prefer to work (check all that apply):

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* 11. I am available to work on the following days (check all that apply):

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* 12. I am available to work at the following time/s (check all that apply):

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* 13. How did you hear about volunteering at the Department of Older Adult Services? (Check all that apply).

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* 14. The Department of Older Adult Services is required by state law to conduct a CORI background check on all volunteers ages 18 and older. A copy of a state issued ID (Driver’s License or other) must be submitted with the completed CORI forms.

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* 15. Please note, completion of this application does not guarantee placement.

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