1 Community Boulevard Wheeling, IL 60090 847-459-2670
Wheeling Senior Services
Volunteer Application Form
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Name
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Phone Number Date of Birth
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Home Address
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City State Zip
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Employed By (if employed) Phone Number
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Address
May we call you at work? yes no
Brief description of work: _____________________________________________________
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Formal Education (Highest year of school completed):______________________________
If you speak a foreign language, which one ______________________________________
Do you drive and have access to a car? yes no
Current community activities: __________________________________________________
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List current and previous volunteer work - list all previous volunteer work including brief
description of duties and activities, dates of service:
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What are your reasons for wanting to participate as a Wheeling Senior Services volunteer?
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Have you had any personal experience involving office duties, crafts, food service, medical
appointment/or other transportation, computer knowledge? If so, explain: ______________
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How did you hear about our senior services?______________________________________
Have you ever been convicted of a crime other than a traffic violation? yes no
If yes, what charge?_____________________Date Relationship
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How long have you lived in the area?________________________________
Wheeling Senior Services reserves the right to make any checks deemed appropriate as to the
suitability of anyone responsible for this confidential work. All information obtained will be held
in the strictest confidence.
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Applicant Signature Date
Wheeling Senior Services
Volunteer Application Form
Part Two
Wr
ite a short summary about your interest in volunteering and how you hope to contribute to
the activities at Wheeling Senior Services and how you hope to benefit from the volunteer
experience.
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Please return the completed application to Wheeling Senior Services, 1 Community
Boulevard, Wheeling IL 60090. Upon receipt and review an appointment will be set up to
speak to our volunteer coordinator. Thank you for your interest.