Volunteering Application – Step 2 - Jewish Family and Children’s Service of Minneapolis

Today's Date*

Name*

First Last

Volunteer role applying for:*

For volunteers who are willing to drive a client:

Are you willing to drive a client?*

(If yes, please complete next section)

Make/model of car

MN Driver's License number

Auto insurance company name & policy number

Have you had any automobile accidents in the past five years

Have you had any speeding tickets or other moving violations in the past five years

If you answered yes to accidents, tickets or moving violations, please explain:

MEDICAL INFORMATION

Do you have any medication conditions (physical or mental) or take any medication that would affect your ability to perform your volunteer duties, or that the Volunteer Services staff should be aware of? If yes, please explain.

REFERENCES

(Please provide contact information for three non-familial references. Please give complete information in order to process your application)

Reference #1

Name*

First Last

Email*

Phone*

Relationship to applicant*

Years known*

Reference #2

Name*

First Last

Email*

Phone*

Relationship to applicant*

Years known*

Reference #3

Name*

First Last

Email*

Phone*

Relationship to applicant*

Years known*

Consent

In making this application to be a volunteer, I agree that if my services involve transporting any person, I will maintain liability and no fault insurance upon my vehicle pursuant to the statutory requirements of the State of Minnesota. I further understand that Jewish Family & Children’s Service of Minneapolis provides no auto insurance coverage for volunteers and does not agree to indemnify me for any legal liability arising out of my transporting any person as a volunteer. I certify to the best of my ability that the information provided on this application is true and accurate.

Note: JFCS of Minneapolis routinely performs criminal and/or motor vehicle background checks for many volunteers positions. For those positions that require a background check, you will receive an email from Sterling Volunteers. You will then be instructed to enter relevant information directly.