Meals on Wheels Spokane/Mid-City Concerns

Note: Information provided within this Volunteer Application remains confidential to Meals on Wheels Spokane.

CONTACT INFORMATION

Today's Date

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(mm/dd/yyyy)

How did you hear about us?

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Name

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First Name

Last Name

Middle Name

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Date of Birth

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(mm/dd/yyyy)

Gender

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Other Names Used

Maiden name, nicknames, previous married name, etc.

Is there anyone over 18 who will accompany you?

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*Individuals who are 18 or over must submit their own application and agree to a background check

No

Yes

Is there anyone under 18 who will accompany you?

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No

Yes

*If under 18, please list their name(s) and ages

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Mailing Address (if different than above)

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone

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Main contact phone

Other Phone

cellphone, work, etc.

Email

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Verify Email

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How do you prefer to be contacted?

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Call

Email

EMERGENCY CONTACT INFORMATION

Emergency Contact

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First and Last Name

Relationship to you

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Mother, Son, Friend, etc.

Emergency Contact Phone

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Emergency Contact Other

work, cellphone, etc.

MISCELLANEOUS BACKGROUND INFORMATION

Are you representing a group, club or employer?

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No

Yes

Group or Club Name

If you answered yes to previous question

Is volunteer interest in order to fill community service hours?

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No

Yes

Community Service contact name and phone

If you answered yes to previous question

Have you ever been convicted of a crime?

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No

Yes

If yes, please explain

Please Note:

*Individuals with convictions of crimes against a person and/or crimes involving illegal substances are not eligible for volunteering with our population.

VOLUNTEER INFORMATION

We are required to have identification on all volunteers. Drivers please provide insurance info also. If you are not driving a route and don't have a valid driver's license you may provide other valid identification such as state-issued ID or a valid passport.

Photo Identification or Driver's License

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Please choose type of ID you are providing for background check. Driver's license is required for volunteer drivers.

Driver's License

State-Issued ID Card

Passport

Other

Upload Driver's License, Photo ID, or Passport etc.

You may upload your driver's license/ID here, or you may fill in your info below and bring it in when you come in for the 1st time.

Driver's License #

*Required for volunteer drivers.

Expiration Date

State Licensed In

Alternate ID Number and Type

Upload Insurance Card

You may upload a photo of your insurance policy here , or you may fill in your info below. You may also bring it in when you come in for the 1st time.

Auto Insurance Company

*Insurance information only required for volunteer drivers.

Insurance Policy #

VOLUNTEER AVAILABILITY

Please indicate your availability and/or preference for volunteer service

Days of the week

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Monday

Tuesday

Wednesday

Thursday

Friday

Any

Preferred Area

Southwest

Southeast

Northeast

Northwest

Downtown

Any

Are you available on short notice?

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No

Yes

Do you have access to a 4 wheel drive vehicle for use in case of inclement weather?

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No

Yes

General Needs and Volunteer Opportunities

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(Check all you are interested in)

Kitchen

Driving/Delivery

Pet Food

Senior Center

Administrative/Office/Clerical

Fundraising/Events

Dishwasher/Cleaning/Janitorial

Statement of Liability: Meals on Wheels Spokane is not responsible for personal injuries or property damage suffered or caused by a volunteer in connection with his or her volunteer activities. I understand and agree to the condition that as a volunteer driver I am expected to maintain my own liability insurance for the duration of my service to Meals on Wheels Spokane.

Confidentiality Statement: It is understood as a volunteer of Meals on Wheels Spokane that I will respect the privacy of all clients by maintaining strict confidentiality. I will not share any specific names or health information about our clients to anyone outside of Meals on Wheels Spokane.

The information I have provided is complete and accurate to the best of my knowledge. For the safety of our clients, I authorize Meals on Wheels Spokane to complete a Washington State criminal background check. I understand misrepresentation by me in this application or violation of the program’s policies or procedures shall be sufficient cause for separation from volunteering at Meals on Wheels Spokane/Mid-City Senior Center.

Please click below before submitting application

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Yes, I agree to the above statements.