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Volunteer Application
Personal Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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Recent Employment


(mm/dd/yyyy)
Students
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Driving Your Senior Friend
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References
Please list two non-family references that you have known for more than one year. Employers, teachers, coaches, ministers, etc. may be used.
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First Name
Last Name

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First Name
Last Name

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Criminal Background
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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.
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(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.