Volunteer Application

Transitions LifeCare does not discriminate in their selection of volunteers, hiring or employment on the basis of race, color, sex, disability, national origin, citizenship, or on the basis of age with respect to persons 18 years or older. No question on this application is intended to secure information to be used for such discrimination. Transitions LifeCare will hold you responsible for the accuracy of the statements you make on this application. Incomplete applications will not be considered.

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone (Home)*

Phone (Cell)

Phone (Work)

May we call you at work?

Yes
No

Email*

How do you prefer to be contacted?*

Phone
Email

Are you 18 years or older?*

Yes
No

How did you learn about volunteer opportunities at Transitions LifeCare?*

What volunteer opportunities are you interested in?

Check all that apply

Select All
Patient & Family Support
Administrative/Office
Specialty - We Honor Veterans
Specialty - Musical Presence
Specialty - Massage
Specialty - Pet Partner
Specialty - Vigil Support
Other

What days & times are you available to volunteer?*

Have you been impacted by a personal loss in the past 12 months?*

Yes
No

Special skills

Check all that apply

Select All
computer
arts/crafts
writing
fundraising
other

Please list languages you speak fluently

Volunteer / Employment history

List most recent first

Agency/Employer

(include position and years of employment)

Agency/Employer

(include position and years of employment)

Agency/Employer

(include position and years of employment)

Are you presently enrolled at a school or university?

If yes, list school and graduation year.

What is your current area of study?

Community Recommendations

Reference forms will be sent to the names provided. Please provide either a mailing address including zip code or an email address for each reference

Name, Mailing or Email address*

I have registered for a Volunteer Information Session.*

Yes
No

I certify that the answers given herein are true and complete to the best of my knowledge*

(type name and date in box)

Phone

I would like to receive information from Transitions LifeCare (includes newsletters, organizational updates and announcements, or solicitations).

Yes
No

Comments

This field is for validation purposes and should be left unchanged.