Volunteer Application You can submit this completed form via: E-mail to firstname.lastname@example.org, Fax to (719) 884-2301, Postal mail to, or in-person at: Silver Key Senior Services, Volunteer Program Manager, 2250 Bott Ave, Colorado Springs, CO 80904. Step 1 of 2 50% Are you a:*New volunteer to Silver KeyReturning volunteer to Silver KeyAre you a current client of Silver Key:*YesNoIf yes, which department?Are you a past client of Silver Key:*YesNoVolunteer IdentificationInformation provided in this section is used for identification purposes only.Legal Name* First Last Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home Phone*Cell PhoneWork PhoneEmail Date of Birth* Gender*MFDriver License #*Driver License issuing state:*Driver License expiration date:*Emergency ContactsWho can we contact in case of an emergency?Name* First Last Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home Phone*Cell PhoneWork PhoneRelation*Volunteer Interest and AvailabilityWhat areas of volunteering are you interested in? (Check all that apply)Transportation Van/Bus Driver* Facilities Building Maintenance Nutrition Customer Service Delivering Meals Food Pantry Sorting Kitchen Aide (several locations available) Case Management Errand Running /Companionship* Retail Thrift Store Staff* Warehouse Assistance Other Duties Clerical/Data Entry Committee/Events Fundraising Reception Anything, really. Tell us what days and times you are available to volunteer:*Mon: Tues: Wed: Thurs: Fri: Sat*:*Saturday opportunities are limited to retail, case management and recreational driving in transportation.Do you have a set amount of hours that you are required to contribute in a community/public service program?*YesNoIf yes, please indicate number of hours:By what date do these hours need to be served?Name of the program or agency: Save and Continue Later Education/SkillsWhat is the highest level of education you have achieved?*GEDH.S. DiplomaB.A. / B.S.Master's DegreeHigherPlease rate your computer skills:*NoneOKGoodGreatInternet BrowsingMicrosoft WordMicrosoft ExcelMicrosoft OutlookMicrosoft PowerPointMicrosoft AccessTell us about any other language(s) you understand/speak/read/write in addition to English:Do you..Please check all that apply Understand Speak Read Write Tell us about any other language(s) you understand/speak/read/write in addition to English:Do you..Please check all that apply Understand Speak Read Write DisclosureAs part of our background and investigation, we may obtain consumer reports or prepare an investigative consumer report. The investigative consumer report may consist of contacting all supplied prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports and driving history records. Under the provisions of the Fair Credit Reporting Act (1681-1681y), before we can seek such reports, we must have your written permission to obtain the information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your Rights under the Fair Credit Reporting Act, go to http://www.consumerfinance.gov/learnmore.Background Check Release*Advisement The elderly are a potentially vulnerable, high-risk group. Silver Key Senior Services asks that you provide authorization for a criminal record check prior to your potential volunteer placement. The criminal record check is conducted via a secure website. It is returned electronically to the Silver Key administrative staff and becomes a part of your volunteer record. Acknowledgement I have read the above statement and I understand Silver Key Senior Services’ requirement for a criminal record check prior to further consideration of my application for volunteer placement. I understand that I am being asked to voluntarily provide information including my social security number. I further understand that failure to provide the information will disqualify me from further consideration concerning the volunteer position for which I might apply. I accept. I decline Drug and Alcohol Testing*Per the Department of Transportation (CDOT) regulations, drug and alcohol testing will be required for all volunteers that drive a Silver Key vehicle and/or transport any Silver Key client in their own vehicle. Volunteers who meet this criteria will be subject to testing once training is completed as well as periodic quarterly random drug testing. (Federal Transit Administration (FTA) regulation 49 CFR Part 655) I accept I decline Driving Record Release*Driving records may be obtained as part of Silver Key Senior Service’s evaluation of my volunteering. The reports may be procured to provide an assessment of my insurability under the Company’s insurance coverages. By signing this disclosure, I hereby authorize Silver Key Senior Services, Inc. to procure such reports and additional reports about me, as appropriate to evaluate my insurability or for other permissible purposes. I accept. I decline Photo Release*I hereby agree to allow Silver Key to take my photograph while volunteering for Silver Key; I grant ownership of any such photographs to Silver Key and specifically release any rights or claims to same. These photographs may be used for advertising, communication, and/or commercial purposes. I accept. I decline Release of Liability*I agree not to hold Silver Key Senior Services liable in the case of injury or accident. I accept. I decline Confidentiality Statements – Your commitment to Silver Key and its clientsWe have a policy of strict confidentiality. Names, specific conditions and/or other personal details are to be held in strict confidence. By all means, share the stories, the successes and the warmth – but please leave out the personal details. This includes detailed information about clients, other volunteers, donors and staff.AgreementI assert that the information provided above and on previous page(s) is accurate to the best of my knowledge and I agree with the terms stated herein. I understand that declining any of the above information needed may disqualify me from further consideration concerning the volunteer position for which I am applying for.If you are submitting this application and release electronically, you will sign it later during your in-person interview.Type your Legal Name* First Last Signature*Date* PhoneThis field is for validation purposes and should be left unchanged. 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