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Volunteer Application

Personal Information


*







Recent Employment



(mm/dd/yyyy)

Students


Driving Your Senior Friend


References

Please list two non-family references that you have known for more than one year. Employers, teachers, coaches, ministers, etc. may be used.

(Name, Phone Number, Email Address)

(Name, Phone Number, Email Address)

Criminal Background






Permission

Because I will be working with older adults who may be vulnerable, I understand that it will be necessary for Befrienders to conduct a criminal background check. I hereby grant Befrienders and its agent, ClearStar Services, permission to do so. I authorize all law enforcement agencies and references to provide the necessary and relevant information about me to Befrienders and I release them from any and all liability as a result of providing that information. I hereby declare that all of the information provided in this application is complete, true and correct to the best of my knowledge.


(mm/dd/yyyy)

A background check currently costs Befrienders $15.00. A donation on the part of the applicant to help defray this cost would be appreciated.