PPA Volunteer Online Form

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

PLEASE READ THIS CAREFULLY!

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