Volunteer Profile Entry
Enter Volunteer Information
Your Name
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First Name
Middle Initial
Last Name
If you are volunteering with a group/company/organization, please add the name of the group here:
Is your ‘Court Ordered Community Service?
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Yes
No
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What volunteer roles are you applying for? (you can select more than one choice)
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Meals on Wheels
Friendly Caller
Seasonal Yard Cleanup
Goldenberry Adult Day
Continuation of Entry of Volunteer Information
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
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Street
Street Address Line 2
City
State_Province
Postal_Code
Gender
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Male
Female
Other
Birth Date: MM-DD-YYYY
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-
Month
-
Day
Year
Date
Race
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Caucasian
Black
Asian
Hispanic
Multi-Racial
Pacific Islander
American Indian
Other
Emergency Contact Person
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Relationship to Emergency Contact Person
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Spouse
Other
Phone Number for Emergency Contact Person
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Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License Number
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State issued in:
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Mi
Other
Upload an Image of your Driver's License
Browse Files
Drag and drop files here
Choose a file
If you are unable to upload a copy of your driver's license we will follow up with you before processing your application.
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of
Upload a Copy of your auto insurance
Browse Files
Drag and drop files here
Choose a file
If you are unable to upload a copy of your auto insurance we will follow up with you before processing your application.
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Upload a photo for your Volunteer Badge
Browse Files
Drag and drop files here
Choose a file
If you are unable to upload a photo we will follow up with you before processing your application.
Cancel
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Required Release of Liability and Consents
VOLUNTARY ASSIGNMENT: Meals on Wheels, Friendly Caller, Adult Day & Seasonal Yard Cleanup. In consideration of accepting the above listed voluntary assignment with the County of Macomb, Office of Senior Services, I do hereby, release the County of Macomb and its Officials, Agents and Employees of the County from liability for any personal injury, bodily injury and/or damage to property which I may suffer while participating in the above listed voluntary assignment. This includes all risks that are connected with this activity whether foreseen or unforeseen. I agree to accept all medical expenses for any and all medical services of which I may receive as the result of injury to myself while participating in the above listed voluntary assignment. It is further mutually agreed and understood that the above listed voluntary assignment is not intended to be of a permanent nature, but rather for a voluntary purpose for a limited period of time. By receiving this document in an electronic format and by providing my electronic signature in the space below, I acknowledge and agree to conduct this transaction by electronic means, and my electronic signature below is my overt act demonstrating my intent to be bound by this agreement. I acknowledge that Office of Senior Services also agrees to conducting this transaction by electronic means. By signing this agreement I fully understand and agree that I am not entitled to or shall receive any benefits to which County employees are entitled, including but not limited to, overtime, retirement benefits, worker’s compensation and injury leave benefits. I am of lawful age and legally competent to sign this agreement.
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I have read this statement
I understand the terms of this agreement and sign this document as my own free act. (Print/type legal name:)
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As a prospective volunteer of Office of Senior Services, I understand that it is this agency’s policy to complete a background check that includes: criminal history, driving record, professional licensure and sanctions list review as their screening process using the information provided below. I understand that the above information is required by the central records division of the Michigan State Police, Lansing, Michigan. This is also a requirement of the Michigan Department of Health and Human Services/ACLS Bureau. I authorize Office of Senior Services to utilize the above information to ensure compliance with all applicable policies, regulations and contract agreements. By receiving this document in an electronic format and by providing my electronic signature in the space below, I acknowledge and agree to conduct this transaction by electronic means, and my electronic signature below is my overt act demonstrating my intent to be bound by this agreement. I acknowledge that Office of Senior SErvices also agrees to conducting this transaction by electronic means. (Please type/print your legal name)
*
I have read this statement
I understand the terms of this agreement and sign this document as my own free act. (Print/type legal name:)
*
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Volunteer Schedule and Preferences
Type of Meal Delivery Preference
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Meals on Wheels Volunteer Driver, assigned a route for delivery during week at lunch time
Substitute Meals on Wheels Volunteer Driver, filling in as needed during the week at lunch time
Holiday Meals on Wheels Driver (Easter, Thanksgiving & Christmas)
Other
What is your availability? (Check all that Apply)
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Mondays 11:00am-1:00pm
Tuesdays 11:00am-1:00pm
Wednesdays 11:00am-1:00pm
Thursdays 11:00am-1:00pm
Fridays 11:00am-1:00pm
Other
How did you hear about our volunteer opportunities?
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A current volunteer told me about the fun!
Word of Mouth
Macomb County Office of Senior Services website
Social Media (i.e. Facebook, Twitter)
Newspaper
Door Hanger about Meals on Wheels
FCA Motor Citizens Volunteer Program
Team GM Cares Program
Yard Signs
Other
Name of current volunteer who told you about us? (We want to thank them!)
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Please View our Meals On Wheels Video.
*
I completed the orientation video successfully
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Thank you for completing your application. Click "submit" to finish your application.
Thank you for your interest, a member of our staff will contact you within 2 business days regarding your volunteer application.
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Notice For Court Ordered Participation:
The Meals on Wheels volunteer program does not participate in court ordered community service. Thank you for your interest.
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