Volunteer

Personal Information

What volunteer position are you interested in?

Name*

First Last

Address

Street Address City State ZIP Code

Contact Phone*

Email*

Gender Identity

Male

Female

Other

Decline to State

Date of Birth

Gender Identity - Other

Are you over the age of 55?

Yes

Are you a veteran?

Yes

If you are over the age of 55, please select an age range:

Interests

How did you hear about Gold Country Senior Services?

What is your interest in and motivation for volunteering with GCSS?

In what other areas are you interested in volunteering? (check all that apply)

Board of Directors

Meals on Wheels Driver

Firewood Program

Senior Center

Senior Advisor

Packing Meals

Other

Volunteer Interest - Other

Volunteer Experience

Have you volunteered before?

Yes

Name of Agency

Volunteer Position

Emergency Contacts

Name

First Last

Relationship to Volunteer

Phone

Name

First Last

Relationship to Volunteer

Phone

Driving Information (Volunteer Driver Only)

If you are volunteering for a position that requires driving, GCSS requires a valid driver's license, current DMV driver's record, and proof of automobile insurance. Staff will obtain copies of proper documentation when needed.

Background Check & Required Trainings

All volunteers having contact with seniors will be required to complete a background check and any required trainings. Staff will provide the information to complete these.

Self Certification

Signature*

I self-certify that all statements made on this application are true, complete, and correct to the best of my knowledge.

Date

Parental/Guardian Consent

To be completed if volunteer is under 18 years of age.

Signature of Parent/Guardian

I give my consent for my child, named on page one of this application, to provide volunteer services to GCSS. I also give GCSS my consent to obtain any emergency medical treatment necessary for the safety of my child.

Name of Parent/Guardian

First Last

Name of Volunteer Applicant

First Last

Upload your application

If you have completed the application and would like to upload it here you can. Otherwise, please mail it to PO Box 968, Grass Valley, CA 95945

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 10 MB, Max. files: 4.

Phone

This field is for validation purposes and should be left unchanged.

Volunteers are crucial to all our programs in providing services to seniors in need. Here is how you can help:

Meals on Wheels Driver

Kitchen Assistant/Meal Packer

Senior Firewood Volunteers

Board Member

Fill out the volunteer form below and a member of our staff will be in touch so you can start volunteering soon!

Personal Information

Interests

Volunteer Experience

Emergency Contacts

Driving Information (Volunteer Driver Only)

Background Check & Required Trainings

Self Certification

Parental/Guardian Consent