Seniors Helping Others
"The Volunteer Resource for Southern Rhode Island"
RSVP of Washington County and Jamestown
25 St. Dominic Road, Wakefield, Rhode Island 02879
Tel: (401) 789-2362 Fax: (401) 789-1138 e-mail: seniors@netsense.net

Volunteer Appication Form

If you wish to become a volunteer at Seniors Helping Others, please fill out the request form below. Our Volunteer Coordinator will review the information and contact you as soon as possible.

Please provide name, date of birth, and gender:

First Name

Last Name

Date of Birth

Sex Male Female

Please provide contact information:

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

E-mail

Town of Legal Residence

Block Island Charlestown Exeter Hopkinton Jamestown Narragansett
North Kingstown Richmond South Kingstown Westerly

Please provide the following emergency contact information:

Name

Work Phone

Home Phone

Are you a licensed driver?:

Yes:    No:     Driver License #:   State:

I UNDERSTAND THAT IF I USE MY PERSONAL AUTOMOBILE IN MY 
VOLUNTEER SERVICE, I WILL ARRANGE TO KEEP IN EFFECT THE
MINIMAL AUTOMOBILE LIABILITY INSURANCE.

RSVP supplemental Accident Insurance Beneficiary Designation (applicable for those 55 years and older):

Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

VOLUNTEER INTERESTS AND SKILLS

CLICK THE MOUSE IN THE CHECKBOX IN THE LEFT HAND COLUMN BELOW FOR EACH AREA IN WHICH YOU ARE INTERESTED IN VOLUNTEERING. ALSO IN THE "IMPORTANCE" BOX NEXT TO YOUR AREAS OF INTEREST, RANK YOUR INTEREST IN ORDER OF IMPORTANCE. USE NUMBERS FROM 1 TO 5 IF YOU ARE INTERESTED IN 5 AREAS AND USE NUMBERS FROM 1 TO 10 IF YOU ARE INTERESTED IN 10 AREAS. THEN FOR EACH AREA CLICK THE MOUSE IN ONE OF THE FIVE CIRCLES INDICATING YOUR SKILL LEVEL. SELECT 1 FOR A HIGH LEVEL OF SKILL, WHICH WOULD APPLY, FOR EXAMPLE, IF THIS HAS BEEN YOUR CHOSEN CAREER AREA. CHOOSE A 5 TO INDICATE NO EXPERIENCE, BUT A WILLINGNESS TO LEARN.

Advocacy, Child                          Importance (1 to 10) Skill: 1 2 3 4 5
Advocacy, Adult                          Importance (1 to 10) Skill: 1 2 3 4 5
Animal Care                                  Importance (1 to 10) Skill: 1 2 3 4 5
Bookkeeping/Accounting        Importance (1 to 10) Skill: 1 2 3 4 5
Clothing Shops/Thrifts Shops     Importance (1 to 10) Skill: 1 2 3 4 5
Companionship (Friendly visits) Importance (1 to 10) Skill: 1 2 3 4 5
Courts/Government                    Importance (1 to 10) Skill: 1 2 3 4 5
Crafts/Knitting                            Importance (1 to 10) Skill: 1 2 3 4 5
Computers-data entry                Importance (1 to 10) Skill: 1 2 3 4 5
Computers-word processing   Importance (1 to 10) Skill: 1 2 3 4 5
Computers-Maintenance           Importance (1 to 10) Skill: 1 2 3 4 5
Environmental                              Importance (1 to 10) Skill: 1 2 3 4 5
Fundraising                                   Importance (1 to 10) Skill: 1 2 3 4 5
General_Office                              Importance (1 to 10) Skill: 1 2 3 4 5
Healthcare_Facilities                   Importance (1 to 10) Skill: 1 2 3 4 5
Home Based (Telecare, etc        Importance (1 to 10) Skill: 1 2 3 4 5
HouseholdRepairs                       Importance (1 to 10) Skill: 1 2 3 4 5
Libraries                                          Importance (1 to 10) Skill: 1 2 3 4 5
Museums                                        Importance (1 to 10) Skill: 1 2 3 4 5
Meals_On_Wheels_Mealsite       Importance (1 to 10) Skill: 1 2 3 4 5
Meals_On_Wheels_Delivery       Importance (1 to 10) Skill: 1 2 3 4 5
Music-Chorus                                Importance (1 to 10) Skill: 1 2 3 4 5
Music-Instrument                           Importance (1 to 10) Skill: 1 2 3 4 5
Newsletter/Publicity                      Importance (1 to 10) Skill: 1 2 3 4 5
Photography                                  Importance (1 to 10) Skill: 1 2 3 4 5
Schools-Kindergarten                  Importance (1 to 10) Skill: 1 2 3 4 5
Schools-Elementary                      Importance (1 to 10) Skill: 1 2 3 4 5
Schools-Middle6to8                      Importance (1 to 10) Skill: 1 2 3 4 5
Schools-Secondary9to12            Importance (1 to 10) Skill: 1 2 3 4 5
SHO Advisory Council                 Importance (1 to 10) Skill: 1 2 3 4 5
SHO Board of Directors               Importance (1 to 10) Skill: 1 2 3 4 5
SHO Committees                          Importance (1 to 10) Skill: 1 2 3 4 5
SHO_Office                                     Importance (1 to 10) Skill: 1 2 3 4 5
Shelter/CrisisCenters                  Importance (1 to 10) Skill: 1 2 3 4 5
Soup Kitchen                                 Importance (1 to 10) Skill: 1 2 3 4 5
Sports/Dance/Games                   Importance (1 to 10) Skill: 1 2 3 4 5
Transportation                               Importance (1 to 10) Skill: 1 2 3 4 5

Comments About Assignment Desired (type of work or specific non-profit organization):

Life Skills/Volunteer Experience:

Previous Education/Occupation:

Reference 1:

Name

Relationship

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

Reference 2:

Name

Relationship

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

Reference 3::

Name

Relationship

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

Initial Volunteer Placement(s):

Date Submitted:

-- mm/dd/yy

Volunteer Appication Form

Send mail to seniors-rsvp@netsense.net with questions or comments about this web site. Copyright © 2002 Seniors Helping Others Last modified: December 06, 2002

Send mail to seniors-rsvp@netsense.net with questions or comments about this web site.
Copyright © 2002 Seniors Helping Others
Last modified: December 06, 2002