Care Partners of Cook County · Volunteer Application-Chore

Applicant Information

Name

*

First Name

Last Name

Mailing address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Physical address (if different from mailing address)

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email

*

Verify Email

*

Preferred phone

*

Okay to text?

*

Yes

No

Alternate phone

Okay to text?

Yes

No

Your employer

Occupation

Work phone

Okay to call you at work?

Yes

No

Emergency Only

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The following information is required for background check

Have you lived in Minnesota for the last five years?

*

Yes

No

In no, please list address(es) for the last five years and dates of residence for each

Aliases used (i.e. maiden name)

Race

*

Asian or Pacific Islander

African American

Native

White

Unknown/Other

Hair color

*

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Your Emergency Contact Information

Emergency contact name

*

First Name

Last Name

Relationship to you

*

Phone

*

Email

Verify Email

Address

*

Personal References

Please provide two personal references who are not family members. Include complete mailing addresses, as references may be verified by phone or mail.

Reference #1

Name

*

First Name

Last Name

Phone

*

Mailing address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

How do you know this person?

*

Number of years known

*

Reference #2

Name

*

First Name

Last Name

Phone

*

Mailing address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

How do you know this person?

*

Number of years known

*

Availability

Would you consider volunteering on a weekend?

*

Yes

No

Weekend availability notes

Would you consider volunteering in the evening?

*

Yes

No

Evening availability notes

In which geographic areas are you willing to volunteer?

*

City of Grand Marais

Gunflint Trail

West End (Lutsen/Tofte/Schroeder)

East End (Croftville/Hovland)

Grand Portage

About You

Do you have any physical restrictions?

*

(i.e. weight bearing limits, mobility issues, etc.)

Are you a U.S. Veteran?

*

Yes

No

Branch of Service

Do you know a language other than English?

*

Yes

No

Language

Education/special training

Previous volunteer experience

*

Previous experience with older adults

*

Chore Interest

Please check the service categories in which you may be willing to work.

Please note that we work on ground level or single story projects only. We do not help with jobs that require a building permit or the use of a chain saw. Moving assistance is limited to packing or moving boxes - we cannot help move furniture, appliances or large household objects.

Housekeeping

Cleaning

Laundry

Dishes

Cooking

Organization (closets, cabinets, etc.)

Household Chores

Wash windows

Clean gutters

Clean garage

Rearrange furniture

Clean/detail car

Change storm windows

Fall/spring organizing

Take recycling/trash to county disposal site

Minor Home Repair/Household Maintenance

Minor carpentry

Minor electrical

Faucet/toilet repairs

Paint (exterior)

Paint (interior)

Appliance problem-solving

Minor roof repair

Replace light bulbs/batteries

Safety adaptations (install grab bars, stair grips, etc.)

Yard Work

Mow

Rake

Trim trees/shrubs

Plant/weed

Till garden

Snow Removal

Shovel

Operate snow blower

Remove roof snow

Moving Assistance

Pack boxes

Move boxes

Miscellaneous

Assist with electronics (cell phone, email, computer, etc.)

Deliver groceries/supplies

Pet care

Read/sort mail

Wood provision (stacking/moving)

Other

Please describe other chore interest(s)

Thank you!

A copy of this application will be available at your in-person meeting for your review. You will be asked to sign a statement of declaration certifying that the information you have provided on this application is true.