Volunteer Application - Bloomfield Township

First Name *

Middle Initial

Last Name *

Street Address *

City *

Zip Code *

Primary Phone Number *

Primary Phone Type

Secondary Phone Number

Secondary Phone Type

E-mail

(if used regularly)

Date of Birth *

Are you currently employed? *

Yes

No

If so, how many hours per week are you employed?

Are you a business owner? *

Yes

No

Are you a Bloomfield Township resident? *

Yes

No

Education Level *

(select highest level completed)

High School

College

Graduate School

Vocational/Training

If applicable, list the degree received.

Previous Volunteer Experience:

References

Please list up to three (3).

(Do not include relatives or former employers)

Name - Reference #1

Address - Reference #1

Phone - Reference #1

Name - Reference #2

Address - Reference #2

Phone - Reference #2

Name - Reference #3

Address - Reference #3

Phone - Reference #3

Please indicate which volunteer opportunity you are interested in below. *

Meals on Wheels Driver

Telephone Reassurance/Friendly Caller

Availability

Select all times that work for you.

Monday

Morning

Afternoon

Evening

Tuesday

Morning

Afternoon

Evening

Wednesday

Morning

Afternoon

Evening

Thursday

Morning

Afternoon

Evening

Friday

Morning

Afternoon

Evening

Frequency *

Please Specify

Describe how frequently you would like to volunteer.

Today's Date *