Meals On Wheels Volunteer Application

Senior Nutrition Services
847 F Street
West Sacramento, 95605

Local: (916) 444-9533
Toll Free: (877) 434-8075
Fax: (916) 874-7705
Email: MOW@saccounty.net

* Required Fields are marked with bold text

Personal Information


First Name	Last Name	Date Of Birth Enter date as dd/mm/yyyy
Phone	Email	Message Phone
Address		City
State	Zip Code

Person To Contact in an emergency?

First Name	Last Name
Relationship	Phone

Please list two people we can contact as personal references:

First Name:	Last Name:	Phone:
First Name:	Last Name:	Phone:

Volunteer Information:

Where did you hear about Meals On Wheels?

Do you have a chronic illness or disability? YesNo If yes, please explain

Prior Volunteer Experience:

Professional, Business, or Vocational Experience:

Knowledge of Foreign Language?

Special Skills, Interests, or Hobbies?

Any additional information you would like to add:

Preferred Activity

Meals On Wheels: Delivering meals to seniors homes
Kitchen: Food preparation - assembling meals, cupping food into serving trays
All Season Cafe: Congregate style meals for seniors - greeting services and check-in, helping with clean up
Promotions: Working behind the scenes - answer phone calls, filing, and stuffing envelopes
Events: Helping with special events and projects - assisting at fundraisers and other special events
College Internship: Dietetic internships (must be referred by instructor to volunteer for internship)

Please answer the supplemental questions that relate to your preferred activities:

Volunteer Agreement

I authorize the Senior Nutrition Services to request a law enforcement agency certification relating to criminal records.
I agree to abide by the procedures established by the Senior Nutrition Services in the delivery of meals to the elderly. Although I am not an employee of SNS, I understand that I can be dismissed should my actions or performance, as a volunteer and representative of the Agency, be inconsistent with program standards. I also understand that I am not covered under the SNS liability, accident, or injury insurance.
All volunteers are encouraged to remain active for a minimum of one year.
Each volunteer must maintain a firm commitment to professional conduct:
- Client files and or cases must be held in strict confidence.
- Notification is necessary when absent from volunteer duties.
- Advance notification of at least two weeks should be given when a volunteer plans to become inactive,
Each volunteer is required to attend the volunteer orientation and is encouraged to attend in-service training.

I certify that all the statements in the application are true and complete to the best of my knowledge.

Applicant's Signature	*typed in lieu of hand signed, real signature required later
Today's Date

Parent/Guardian Signature (if under 18)	*typed in lieu of hand signed, real signature required later
Relationship