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I would like to be a: _____ Regular Driver (same route, same day each week) _____ Substitute Driver (on call, as needed when available) Please tell us how you found out about Meals on Wheels___________________________________________________ Place of Employment______________________________________________________________________________ Other Clubs/Organizations of which you are a member__________________________________________________ ________________________________________________________________________________________________ Also interested in: _____Fundraising & Special Events _____Public Relations _____Volunteer Recruitment _____Serving on MOW Board of Directors Please list 2 references, 1 personal, 1 professional (may use staff of another agency for which you volunteer, church, etc.). 1. ______________________________________________________________________________________________ 2. ______________________________________________________________________________________________ Have you been, or do you stand to be, convicted of either a felony or a sex offense? NO_____ YES_____ SCOPE-MOW will deliver meals to any homebound individual with a medical need for a home-delivered, nutritious lunch. Any person who has such a medical need and does not have anyone to assist in the preparation of meals is eligible. We do not discriminate based on any particular illness, age, race, religion, sex, or sexual orientation. Meals on Wheels will do everything in its power to respect client confidentiality and to ensure volunteer safety. Please read and sign the following statement: I understand that I may deliver meals to clients diagnosed with an infectious disease, or to clients who may have an infectious disease but not know it. signature_______________________________________________________________________________________ |
