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To begin the enrollment process, please complete the following enrollment form. The Coordinator for your county will reach out to you soon.
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RSVP Volunteer Enrollment Form
Name
*
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Last
Address
*
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--- Select state ---
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*
Ashtabula
Columbiana
Crawford
Greene
Huron
Jefferson
Mahoning
Marion
Montgomery
Morrow
Portage
Seneca
Stark
Trumbull
Wyandot
Phone
*
Birthdate
*
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Gender
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Prefer to Not Answer
Would you be willing to answer additional demographic information?
Yes
No
Ethnic Group
African American
Native American/Alaskan Native
Hispanic
Caucasian
Asian, Pacific Islander
Other
Are you currently serving in the Armed Forces?
Yes
No
Are you a Veteran?
Yes
No
Do you have family members that are Veterans or currently serving in the Armed Forces?
Yes
No
Email
*
Would you like to receive our newsletter?
Yes
No
Shirt Size
*
Please Select One
Small
Medium
Large
XLarge
XXLarge
XXXLarge
How did you find out about RSVP?
RSVP Volunteer Referral
Friend Referral
RSVP Recruitment Event
Newspaper
RSVP Website
Other
Emergency Contact
Emergency Contact Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
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Ohio
Oklahoma
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Relationship
Beneficiary for RSVP Supplemental Accident Insurance
Same as Emergency Contact?
*
Yes
No
Beneficiary Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Relationship
Volunteer Interest & Additional Information
Please check all items below that interest you:
Transportation
Food Pantry Support
Mentoring
Financial Literacy Education
Companionship
Serving Hot Meals
Job Training
Health Information Referrals
Home Meal Deliveries
Fundraising
Housing Repair
Advisory Council
Unknown
Other
Have you ever been convicted of a crime?
*
Yes
No
Please explain:
*
Are you willing to submit to a criminal background check?
*
Yes
No
Driver's License
Click or drag a file to this area to upload.
We are required to obtain a copy of every volunteers driver's license before service begins to complete a sex offender check at NSOPW.gov You may upload your driver's license now, or submit it to your counties RSVP Coordinator.
Special accommodations needed or limitations we should be aware of?
What is your availability?
Will you be driving for service? (e.g., transportation, home meal deliveries, etc.)
*
Yes
No
Unknown
Insurance Card (Must be current)
Click or drag files to this area to upload.
You can upload up to 3 files.
If you are driving for service for RSVP, we must maintain a copy of your insurance card at all times. Mileage is reimbursed at a rate of $0.25 per mile.
By electronically signing below, I submit that I am at least 55 years of age and that I reside in, or nearby, the community served by RSVP. I have read and understand the contents of the RSVP Handbook and agree to abide by the rules and regulations stated therein. I agree to serve without compensation and hereby volunteer my services with RSVP of Family & Community Services.
Electronic Signature
Next
Photo Release
I hereby grant Family and Community Services, Inc's AmeriCorps Seniors programs and its cooperative partners (volunteer stations, station representatives, local and national media and program staff) the permission to use my likeness in a photograph in any and all of its publications, including, but not limited to, website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Family and Community Services, Inc's AmeriCorps Seniors Programs and will not be required to be returned or forwarded to me directly. I hereby irrevocably authorize Family and Community Services, Inc's AmeriCorps Seniors Programs and its cooperative partners to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing volunteer service under the AmeriCorps Programs or for any lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive my right to royalties or other compensation arising or related to the use of the photography. I hereby hold harmless and release and forever discharge Family and Community Services, Inc's AmeriCorps Seniors Programs and its cooperative partners from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 18 years of age or over and am competent to contract my own name. I have read this release before signing and I fully understand the contents, meaning and impact of this release.
I agree:
*
I will allow my photo to be taken.
I choose to NOT allow my photo to be taken.
I understand that it is my responsibility to make sure that I am not in any photographs that are being taken for publication and/or publicity of any AmeriCorps Seniors Program or activity while I am volunteering.
Photo Release
*
By signing here, you acknowledge the photo release policy.
Next
Drug/Alcohol Free Workplace Policy
Any employee/volunteer of Family & Community Services, Inc. who is found to be taking part in the unlawful manufacturing, distribution, dispensing, possession or use of a controlled substance or alcohol in the workplace will face disciplinary action as outlined in the agency’s Administrative Manual and may face criminal penalties as well. The consequences include immediate suspension, meeting with the Supervisor within three days and development of a corrective plan. If the employee/volunteer does not carry out the corrective action plan as agreed, dismissal may result. However, depending upon the circumstances of the situation, an employee/volunteer may face immediate dismissal. Any employee/volunteer of Family & Community Services, Inc. must inform the Human Resources Director of any criminal drug statute conviction no later than five days after such conviction. Family & Community Services, Inc. is obligated under the U.S. Department of Health and Human Services Drug Free Workplace Requirements to notify HSS of any such conviction of an employee. When so notified by an employee of a conviction, the agency must take action within thirty days. The actions are either to (1) terminate employment of the individual, or (2) require this employee/volunteer to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state or local health, law enforcement or other appropriate agency. In an effort to prevent or provide early recognition and treatment of drug/alcohol abuses, Family & Community Services, Inc. carries out a drug/alcohol free awareness program to inform employees/volunteers about the dangers of drug/alcohol abuse in the workplace, our policy of maintaining a drug/alcohol free workplace, available counseling and rehabilitation services, and penalties for drug free workplace violations. All employees/volunteers are asked, as a condition of employment, to abide by this workplace requirement.
As an employee/volunteer of Family & Community Services, Inc. I have read, understand, and agree to abide by the Drug/Alcohol Free Work Environment policy outlined above.
*
Employee/Volunteer Signature
Submit
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