Volunteer Application : Get Involved : Befrienders of Bozeman

Personal Information

Name

First Name *

Last Name *

Phone

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Gender

How did you hear about Befrienders?

Highest educational degree achieved?

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Volunteer experience

Hobbies or Interests

Briefly tell why you are interested in Befrienders

Please list any other groups/organizations to which you belong

Are you able to commit to volunteering to visit an older adult for at least one hour/week for a minimum of one year (or two consecutive semesters for students)?

Recent Employment

Organization/Employer 

Date Started Employment 

Students

Are you a student?

If "Yes" please list your major of choice and expected graduation date

Driving Your Senior Friend

Are you interested in driving your senior?

If "Yes" please include your driver's license number and issued state

References

Please list two non-family references that you have known for more than one year. Employers, teachers, coaches, ministers, etc. may be used.

Reference #1 Information

(Name, Phone Number, Email Address)

Reference #2 Information

(Name, Phone Number, Email Address)

I give permission to Befrienders, Inc. to use my photograph for promotional use (promoting our program helps us stay in operation - please help us reach out to others in this way). Please initial if permission is given: 

Criminal Background

Full Name of Applicant

First Name *

Middle *

Last Name *

Alias/Maiden Name

Date of Birth

Have you ever been arrested or convicted of a criminal offense?

If "Yes" please include date and nature of the crime

Permission

Because I will be working with older adults who may be vulnerable, I understand that it will be necessary for Befrienders to conduct a criminal background check. I hereby grant Befrienders and its agent, ClearStar Services, permission to do so. I authorize all law enforcement agencies and references to provide the necessary and relevant information about me to Befrienders and I release them from any and all liability as a result of providing that information. I hereby declare that all of the information provided in this application is complete, true and correct to the best of my knowledge.

Electronic Signature

Date

A background check currently costs Befrienders $15.00. A donation on the part of the applicant to help defray this cost would be appreciated.

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