GrandFriends Volunteer Application
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PERSONAL: 

Last Name:
First Name:
Middle Initial:
Street Address:
City:
State:
Zip:
Telephone:
Email:
Birthdate:
Month:   Day:
Age (check one) 45-59 60-65 66-75 76+

Health Status (Do you have any physical limitations?):  Yes  No 

Name of Personal Physician or Clinic:

In the event of an emergency, notify:
Phone:

Have you ever been convicted of any violation of federal, state, county or municipal law, regulation or ordinance?

No  Yes

If yes, give date, place and disposition

EDUCATION

Check highest grade attained:  6 7 8 9 101112            


College:     1    2    3    4         

If college graduate: 
Degree:
Major:  

Foreign Language:
Speak:
Write:  

Teaching Experience: 
Yes   No 
If yes, please describe: 

WORK EXPERIENCE
(last two years before retirement)

Employer:
Position: 

Employer:
Position:

PERSONAL REFERENCES
(Please list two individuals who can attest to your character. 
No relatives.)

Name:
            Address:
            Phone:
            Years Known:

Name:
            Address:
            Phone:
            Years Known:  

VOLUNTEER PREFERENCES 

Subject or Activity:
Grade Level:  

Area of City or School:

Days/Times Available:

Hobbies, Travel Experience, Special Interests:

Your Signature:
Date:

Updated 9/19/2008