Volunteer Application Form

Please fill out the form below if you are interested in volunteering for our community. Thank you for your consideration.

Name of Volunteer
Date
MM slash DD slash YYYY
Address
Home phone
Cell phone
Work phone
Email Address
Attending school?
If yes, grade and name of school:
Have you volunteered anywhere before?
If yes, please share with us the place you volunteered at, the position you held, your duties, and dates of service.
How did you hear about/why did you choose Montevue Assisted Living?
Are you Currently Visiting a Resident?
Do you have Family living or working here?
Are you being required to volunteer for Community Service?
If “Yes”, for what purpose? How many hours required? By what date? Individual, Group: Is this Student Service Learning?
Can you teach a Craft or Skill?
If “Yes”, what kind?
Allergies:
What kind of volunteer work do you prefer?
Vaccination Records:

List when updated and when you were boosted.
Completed the COVID-19 Orientation:

List the date.
Check your areas of volunteer interests:
Skills/Education
Licensing:
check all that apply
AVAILABLE SCHEDULE (date and time) TO VOLUNTEER:
MM slash DD slash YYYY
Date you can start?
MM slash DD slash YYYY
Emergency contact:
Please list the person's name, relationship, address, home phone, cell phone, work phone, email
Reference Contact:
Please list the person's name, relationship, home number, cell number and work number.
Signature of Volunteer

This will count as your legal signature. *Your signature acknowledges that Montevue Assisted Living is a tobacco free campus.
Junior Volunteer Name

**ALL JUNIOR VOLUNTEERS (under the age of 18) Please have your Parent/Guardian sign and date above acknowledging and approving the volunteer orientation process.
CAPTCHA
Important - Please read!
Please note volunteers who spend 8 hours or more a week in the community are encouraged to have current PPD and flu shot, both of which are offered at the facility free of charge. All applicants must attend a scheduled orientation and have clearances completed before volunteering. Junior volunteers under the age of 14 must be accompanied by an adult during volunteering times. Please email any further comments or questions to Dana Croft at dcroft@citizenssnf.com. Volunteer orientations are held monthly. To set an appointment for an orientation, please call Dana Croft at 240-772-9457 Thank you for choosing Montevue Assisted Living, we look forward to meeting you.

Volunteer Application Form

Important - Please read!