Volunteer Application Form
Please complete this application form if you are interested in becoming a Tabitha volunteer. Once you complete the form, click the submit button at the bottom.
Contact Information
First name:
*
Last name:
*
Title:
Choose
Mr.
Mrs.
Ms.
*
Nickname:
Street 1:
*
Street 2:
Street 3:
City:
*
State:
Choose
68502
AK
AL
AR
AZ
CA
CO
DC
DE
FL
IA
ID
IL
IN
KS
KY
LA
MA
MI
MN
MO
MS
MT
NC
ND
NE
NM
NV
NY
OH
OK
OR
SC
SD
TN
TX
VA
VT
WA
WI
WY
*
Zip:
*
Primary phone:
*
OK to call me here
Email address:
*
Emergency Contact
First name:
*
Last name:
*
Primary phone:
*
Secondary phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Guardian
Mother
Neighbor
Sibling
Son
Spouse
Staff
Supervisor
*
Demographic Information
The following information is used only to help us get a better idea of the demographic make-up of our volunteers.
Sponsoring Organization:
Gender:
Choose
Female
Male
*
Employer (or previous)/School:
*
Church/Place of Worship:
Retired:
Current or retired military:
Email Preferences
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.
What kinds of email would you like to receive?
Electronic newsletters
Recruitment appeals
Schedule reminders
Volunteer Specifics
How did you hear about us?:
Choose
Course Instructor
March for Meals Campaign
Personal Experience
Referral
Social Media/Advertisement
Volunteer Opportunities Website
*
Reason for Volunteering:
Choose
Course Requirement
Diversion
Joining Employer or Church Team
Personal choice
Recent threats to MealsOnWheels Funding
*
Number of Volunteer Hours Needed:
Skills:
Administrative/Clerical
Bilingual
Gerentology
Music - Instrumental/Singing
Nursing/CNA
Nutrition/Dietetics
Background Check Information
To ensure the safety of those we serve, Tabitha conducts background checks.
Date of Birth:
Month
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Day
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Year
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1921
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1918
1917
*
Have you been convicted of a crime?:
Choose
No
Yes
*
If yes, please explain:
Choose
Alcohol-related
Assault
Automotive
Drug Possession
Other
Theft
Social Security Number:
*
Full Legal Name:
*
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
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5
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Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
hours:
Choose
Daily
Monthly
One time
Weekly
Assignment Preference:
Activities Assistant [TNRC\Life Enrichment]
Adult Day Services [TNRC\Volunteers]
Beauty Shop Escort [TNRC\Beauty Shop]
Chapel Escort [TNRC\Pastoral Services]
Connector [TNRC\Volunteers]
Gift Shop Clerk [TNRC\Gift Shop]
Office Volunteer [TNRC\Volunteers]
Print Shop [TNRC\Print Shop]
Reception Desk [TNRC\Communications]
Tabitha Meals on Wheels Delivery [Tabitha Meals on Wheels\Tabitha MOW Delivery]
Additional comments:
Volunteer Acknowledgement
I hereby authorize the release of information regarding my abilities. I further release all persons and Tabitha from any and all liability resulting from the furnishings of such information. All information listed by me on this application is true and correct to the best of my knowledge. I understand that any information that is disclosed to me while volunteering at Tabitha Health Care Services is confidential. Finally, I interpret "volunteer" to mean that I have agreed to work without compensation in money. Having been accepted as a volunteer, I will follow the policies and procedures presented during the volunteer orientation.
In the event of an illness or injury that occurs during volunteer service at Tabitha Health Care Services, I authorize the provision of medical or hospital care deemed necessary, permission to the treating physician or other health care provider to employ diagnostic procedures and medical treatment deemed necessary, and all medical care units to release medical record information to Tabitha Health Care services insurance carrier in order to process claims.
Investigative Reporting Acknowledgement:
I authorize that a thorough investigation may be made in connection with my application for volunteering concerning my character, general reputation, personal characteristics, any criminal record, and driving record and mode of living, whichever may be applicable, for volunteer purposes, consistent with federal and state law.
By checking this box, I apply my electronic signature, approving the statements above:
I Agree
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