AARP ElderWatch Volunteer Application

Please send completed form to:

AARP ElderWatch

1301 Pennsylvania Street #280

Denver, CO 80203

Position you are applying for: ______________________________

NAME ___________________________________________________________________

ADDRESS ________________________________________________________________

CITY _______________________________ STATE ________ ZIP __________________

E-MAIL __________________________________________________________________

EMERGENCY CONTACT NAME __________________     PH _______________________

PHONE H __________________ W ______________________ FAX_________________

PROFESSION _____________________________________________________________

CURRENT OR PREVIOUS (if retired or unemployed) EMPLOYMENT & EMPLOYER

________________________________________________

How did you hear about AARP ElderWatch and our volunteer opportunities?

_________________________________________________________________________

When are you available to volunteer?

Time of Day:         

Day of the Week:

How often per month:

 What attracted you to AARP ElderWatch in particular?

What skills, training or knowledge do you have that would make you an asset to the position you are applying for?

Describe a personal or work situation when you felt or would feel successful.

What training, resources or support do you anticipate needing to do this volunteer work?

What experience do you have working with the public?

Have you been convicted of a felony within the past five years? YES  NO

If YES, please explain: _________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

 Have you declared Bankruptcy in the past 10 years? YES  NO

If YES, please explain:

Please provide two personal or professional references:

Name                                      Address                                                          Relationship

1.

2.

I hereby attest that the above information is true to the best of my knowledge.

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Signature

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