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Individual Volunteer Application Form

Beatrice Place Brentland Woods
Center for Rehabilitation Episcopal Church Home
River Edge Manor Rockwood Center
Seabury Woods

 

Name:
Address:
City:
Zip:
Primary Phone:
Secondary Phone:
Birth Month/Day:
Email Address:
Volunteer Experience:
Employment Experience:
Special Skills or Training:
Select community you wish to serve (check all that apply):
Beatrice Place   Brentland Woods   Center for Rehabilitation  
The Episcopal Church Home   River Edge Manor   Rockwood Center   Seabury Woods   Multiple Sites   No Preference
Volunteer Job Preferred:
Availability & Frequency:
Weekly
Monthly
On Call
Fill In Times Below:
Hours
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
Afternoon
Evening
Are you away for any extended time during the year?
If so, When?

Emergency Contact Information
Name: Home Phone:
Address: Business Phone:
Relationship:    

Professional References (Two individuals who can speak to your character, reputation, and work experience).
Name: Primary Phone:
Address: Secondary Phone:
 
Name: Primary Phone:
Address: Secondary Phone:

OPTIONAL
Faith Community:


Clergy Name:

Phone:
Email:
Have you ever been convicted of a crime (other than traffic violation)?:
If so, please explain:
Do you have a final finding of patient or resident abuse?
Were you ever removed from any type of employment?
Note: Prior criminal conviction is not necessarily a bar to volunteering.
 
I authorize Episcopal SeniorLife Communities to verify the accuracy of information provided on this application and to obtain reference information. I hereby release Episcopal SeniorLife Communities, and party supplying references, from any liability for a placement decision based on such information.
 
Please sign this application by typing your name below.
Signature:
Date:
Referred By:
I understand that, if I am accepted as a volunteer with Episcopal SeniorLife Communities, I will be expected to observe confidentiality with respect to all information regarding my interactions with residents, staff, and family members at ESLC and any knowledge of the contents of confidential records. Failure to adhere to this agreement is ground for immediate dismissal.
 
Click here to submit this application.