Caring Connections Application

First name:

Last name:

Street address:

City:

State:

Zip code:

Email Address

Phone number (home or cell):

Phone number (work):

Date of birth (mm/dd/yyyy)

Employer (if retired, former employer):

Any special skills that may help Meals on Wheels in other volunteer areas

Activities, sports, hobbies, etc.

Previous volunteer experiences

We ask you to call each client 2 times each week. How many clients do you wish to be assigned?

A back ground check will be run on all volunteers at our expense. The following information will only be used for the background check. OUR POLICY: It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Please sign below by printing your full name, thereby giving us permission to run a background check through the Terre Haute Police Department.

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