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831.758.6325

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Personal Information

First Name

Middle Initial

Last Name

Mobile:

Phone: (h)

Phone: (w)

Address

City

State

Zip

Sex

Male Female

Ethinicity

African American White Hispanic Asian Other

I am over 60 years of age

Yes No

Ethinicity Other

Current/former Occupation

What language(s) do you speak

Emergency Contact

Phone No.

What days are you available:

Tuesday

Wednesday

Thursday

Are you available to substitute?

Yes No

How did you hear about Meals on Wheels of the Salinas Valley?

Please list the organization(s) with contact(s) and phone number(s) where you have volunteered or write NONE

BACKGROUND VERIFICATION

Do you have a current California Driver’s License?

Yes No

Do you have any physical limitations that would prevent you from driving and delivering packages of approximately 25 pounds?

Yes No

If yes, what are your limitations?

Distribution Assistant, can you lift 35 – 50 pounds?

Yes No

Are you going to be a volunteer DRIVER?

Yes No

Are you currently a STUDENT?

Yes No

Driver Information

Identification is needed from all volunteers. If your volunteer work for Meals on Wheels will not include driving, please provide one of the following:

California Driver’s License #

Expiration Date

Policy No

Expiration Date

Do you have automobile insurance with at least $50,000 single limit liability or the equivalent ($50,000 bodily injury for each person, $100,000 bodily injury for each accident, and $50,000 property damage for each accident)?

Yes No

Do you understand that volunteer drivers receive no remuneration for their service?

Yes No

Do you understand that your insurance is primary in the event of an accident or injury?

Yes No

Auto Insurance Co. (attach copy of proof of insurance)

Driver Identification Information

California Driver’s License # (attach copy)

Expiration Date

California Identification # (attach Copy)

Expiration Date

California Identification #

Expiration Date

Student Information

School you attend

School Phone

Grade

Student ID # (attach copy)

Your age

Birthdate

Name of parent/guardian (if under 18)

Parent phone

Do we have permission to use your photo for publicity about Meals on Wheels?

Yes No

Upload a copy of your driver’s license and proof of insurances

No File Chosen

You may upload multiple files

Contact Us

Meals on Wheels

534 Abbott Street
Salinas, CA 93901
831.758.6325 - phone

831.758.6518 - fax
[email protected]

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