Volunteer Application

Online Applications

Please fill in our online form below or download our application here.

Your Information

First Name:

Last Name:

Gender:

Male

Female

Address:

City:

State:

Zip:

Birth Date:

(required for background check)

Home Phone:
Work Phone:
Cell Phone:
Email Address:

What is the best way & time to reach you?

How did you hear about volunteering at JSS?

United Way

We receive United Way funds & are required to collect certain statistics, which are reported by category; volunteers' names are never provided.

Race:

Are you disabled?

Yes

Age Range?

18-35

35-54

54+

Employment & Education

Current/Former Occupation:
Employer or School:

Does your employer match employees' volunteer hours with monetary donations to charities?

Yes

Highest Level of Education:

If you are a student, what is your major and year?

Are you being required to volunteer? Explain.

Have you been convicted of a misdemeanor or felony? If you have, please explain.

If yes, which state:

Wisconsin

Other

Experience & Interests

Previous Volunteer Experience; list agencies and what you did:

What experiences have you had that may prepare you to work as a volunteer with Jewish Social Services?

Why have you chosen to volunteer for Jewish Social Services?

Hobbies & Interests:

Groups, clubs, organization memberships (include offices & positions held):

Languages you speak:

Location Preferences:

References

Employers &/or volunteer supervisors, clergy, teachers, colleagues, co-workers are preferred; friends or relatives are not accepted. We suggest getting the references' permission to use their name. At least one reference must be local. List name, phone number (required) & relationship to you.

Name	Phone Number	Relationship to You

Preferences

Do you have a car available to you?

Yes

When are you available?

Monday -	From:	To:
Tuesday -	From:	To:
Wednesday -	From:	To:
Thursday -	From:	To:
Friday -	From:	To:
Saturday -	From:	To:
Sunday -	From:	To:

Your Volunteer Preferences (check any that apply):

	Friendly Visitor - regular visits to an individual who is home-bound, to reduce isolation
	First Friend - establish a relationship with an individual with a disability, needed
	Designated Shopper - Shop for someone who is house-bound or who has no transportation
	Teach English as a Second Language (no knowledge of foreign language needed)
	English conversation partner
	Telephone reassurance
	The Driver Connection: provide transportation to doctor�s appointments, grocery store, etc.
	Bikur Cholim - visiting the sick in the hospital, nursing home or at home, as needed
	Senior Passover Seders
	Medical professional
	Legal professional
	Lechayim Lunchtime Plus: serve food, set-up, clean-up, greet, aid with socialization
	Present a lecture or musical program at Lechayim
	Move donated furniture and household items.
	Have a vehicle to assist with moving furniture & household items
	Computer assistance, as needed
	Deliver donated items
	Other Professional:
	Other:

Anything else you'd like to tell us to help us find the best volunteer placement for you?

Any Additional Comments:

Please read the following carefully before you sign this application

I certify that the statements made by me are true and correct, to the best of my knowledge. I will not withhold information that might affect my application for a volunteer position, and I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Jewish Social Services, or my termination as a volunteer. I grant permission to Jewish Social Services to verify documents I submit and statements I make. I agree to release and hold harmless from liability any person or organization that provides information, as well as Jewish Social Services. I understand that this is an application and not a commitment or promise to provide me a volunteer placement with JSS. My signature below applies to all of the following:
Volunteer Confidentiality - I have discussed and understand the need to protect the privacy of Jewish Social Services of Madison (JSS) and its service recipients, and agree to respect the confidentiality of all client information that I observe and am privy to as a volunteer of JSS. All information regarding individuals is to be kept within the confines of JSS, its programs and/or facilities. Client information is to be discussed only with JSS social service staff.
Additionally, confidential health information is to include all information past, present or future that may reveal something about the individuals' physical and/or mental health.
In the event of an emergency I should call 911.
If I observe anything regarding a JSS client that concerns me, this confidentiality agreement requires that I report it as soon as possible to the social service staff at 608-278-1808, during office hours (Monday-Friday, 9:00-5:00). Confidentiality extends to all public relations material. Volunteers may not discuss JSS clients with any form of media, without prior approval of JSS. The information in Jewish Social Services volunteer records is to be discussed only with JSS social service staff.
Photographic Release - I give permission for personal information, quotes and photographs of me to be used as part of Jewish Social Services' promotional materials, and news coverage.
Criminal Background Check - I understand and accept that policy that criminal background checks are part of this volunteer application, and that this information will be kept confidential. I also understand that I may be denied the opportunity to volunteer or be terminated as a volunteer based on the results of the background check.

I agree to the above terms and conditions.