Volunteers

Guidelines | Volunteer Applications | Pet Pals

Choose the appropriate form:

Student Application

Employee Application

Adults and Retiree Application

Pet Pals Application

 
Student Volunteer Application

Last Name:

First Name:

Middle:

 

Address:

City:

State:

Zip:

HomePhone:

 

Current Occupation or Previous Employment

   

Are you retired?  

 

Volunteer Experience:

Special Training:

Languages:

 

Speak Fluently:

Read:

Write:

Have you been convicted of a crime other than a minor traffic violation?


Days Available:

     

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

 


I am most interested in:  

Who referred you to us? (relative/friend/HHAR employee)

Contact in Emergency:  

Relationship:

Phone:


Hobbies:


Please list two (2) personal/business references:

Name:
 

Relationship:
 

Phone:
 

Name:
 

Relationship:
 

Phone:
 


CONFIDENTIALITY PLEDGE

In complying with the policies/procedures and professional standards of the Home, I will keep any personal or medical information about the residents strictly confidential, not to be shared or discussed with any unauthorized person(s), either inside or outside of the faculty. I have a full understanding of this statement of confidentiality.

Print Name:

Date:

 

 

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