Please complete this application form if you are interested in becoming a Frederick Living volunteer. Once you complete the form, click the Continue button at the bottom.

Contact Information

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

OK to call me here

Work phone:

OK to call me here

Demographics

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

Gender:

Education:

Availability

Please indicate the days and times you are usually available to volunteer.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

Assignment Preference

The following volunteer assignments may currently be available. Please indicate your interests.

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

Relationship:

Employer

Please list your current or most recent employer, if applicable.

Employer name:

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

References

Please provide 2 references who will be contacted once your application is received.

1

2

First name:

Last name:

Street 1:

Street 2:

Home phone:

Email address:

Relationship:

Have you ever been certified as a nurse's aid?

Please provide your registration number.

Have you ever been convicted of a felony?

If yes, please briefly explain.

Special talents or skills

Please list any special talents or skills that you might be able to share with our residents. Is there anything else that you would like to tell us about yourself?

EMail

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Email address:

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Volunteer message

Volunteer Information Center

We provide an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.

Please enter a password that:

Is between 8 and 30 characters long
Contains both letters and numbers.
Contains a combination of both uppercase and lower case letters.

Password:

Confirm password:

I Agree

I understand and agree that submitting this application form does not automatically register me as a Frederick Living volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree