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Last Name First Name Middle Inital Home Address City State Zip Home Telephone Drivers License# Email Address
In Case of Emergency Notify: Name Relationship Telephone Address
Do you smoke? Yes No Why do you want to be a volunteer? What personal strengths and/or special skills would you bring to your roll with PPA? What challenges do you envision you might encounter in this type of work? How did you hear about PPA?
Have you ever been convicted of a crime other than a minor traffic violation? Yes No If Yes, please explain offense and final disposition:
Please be informed that a background check is conducted on all PPA volunteers
In submitting this volunteer application, I understand that an inquiry will be made whereby information is obtained regarding my character, general reputation, educational background, and/or criminal history. I authorize anyone possessing this information to furnish it to Partners in Personal Assistance (PPA) and I release anyone so authorized, & PPA, from all liability and damages whatsoever in furnishing, obtaining or using said information.
In the event I am selected for volunteer status at PPA, I understand that false or misleading information given in my application or interview (s) may result in immediate dismissal. I understand I must abide by all policies & procedures set forth by the Board of Directors.
I understand and agree that if chosen as a volunteer, either I or PPA may end our relationship at any time, for any reason, or for no reason.
Please type your full name below to acknowledge that all of the information provided is both complete and accurate. Full Name
