Volunteer Application Form
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First Name
Last Name
Country
Address Line 1
City
State
Postal Code
Country
Address Line 1
City
State
Postal Code
How would you like us to contact you?

Please briefly list the following in the spaces provided:

Are there specific volunteer opportunities you have heard about that you are interested in or are there certain skills you would like to put to use?

Please list two references that are not related to you, but are familiar with your work and/or relevant skills, either paid or non-paid, whom we may contact. (As a courtesy, please let them know that we may be contacting them).

First Name
Last Name
First Name
Last Name

Have you ever been convicted of a crime? (Required)

I understand that if I use my personal vehicle in my volunteer services, I will arrange to keep in effect automobile liability insurance equal or greater to the minimum requirements of the state of Montana. I will also keep in effect a valid driver’s license.

Initial below for personal vehicle use.

The information that you provide on this application is subject to verification. Falsifications or misrepresentations may disqualify you from consideration for volunteer service. With my acknowledgement below, I certify that all information on this and all attached pages is true, correct and complete to the best of my knowledge and contains no willful falsifications or misrepresentations. I authorize all references and employers to release information they may have about me and I release all persons or companies from any liability or responsibility for providing such information. I understand that I am not an employee of Rocky.

Initial below for Certification of Information.

I understand that selection into some volunteer positions is contingent upon successful clearance of a background check. I understand that I am ineligible to work or serve in this position if I decline to complete the application process, if I provide a false statement about any information provided, if I have been convicted of murder or if I am required to be registered as a sex offender.

Initial below for Certification of Background Check.

Voluntarily and without compensation, I give Rocky permission to record my image and grant Rocky, all rights to use these photographs in any medium for educational, promotional, advertising, or other purposes that support the mission of the agency. I release images in any media now known or later developed.

Initial below for Image Release.

I understand that this may also include use by organizations and entities which provide funding to Rocky.

I understand that it is my responsibility to remove myself from the picture taking area and/or inform the photographer if I do not wish to be photographed.

I acknowledge that I have read and agree to adhere to the initialed conditions listed above.


If you are 55 and older and interested in volunteering with Rocky's Foster Grandparent Program, Senior Companion Program or Retired Senior Volunteer Program (RSVP), please complete this section of the application. Otherwise, please skip this section and click the "Submit this application" button located at the bottom of the page.

Rocky Senior Corps Programs (Age 55+)

This section only needs to be completed by those interested in volunteering with Foster Grandparents, Senior Companions or RSVP.

 

I understand it is unlawful to retaliate against any person who, or organization that, files a complaint about discrimination. In addition to filing a complaint against local and state agencies that are responsible for resolving discrimination complaints, I may bring a complaint to the attention of the Corporation for National and Community Services. I am aware that contact information is on Rocky Mountain Development Council, Inc. website.

 

Placement with Senior Corps programs includes free volunteer insurance coverage. As a Senior Corps volunteer, coverage is automatic and free of cost to you as long as you are an active enrolled member of Senior Corps. Coverage includes a small death benefit, excess accident medical, excess volunteer liability and excess automobile liability coverage while performing volunteer duties. This coverage does not apply to any damage to your vehicle - you must maintain your own auto liability coverage at least equal to the state-required minimums.

Insurance Beneficiary for Senior Corps Supplemental Accident Insurance:

Other Information

Senior Corps is often asked to provide demographic information pertaining to volunteer members. Please provide the following informational (Optional).

Are you a veteran?
Are you an active Military Member?
Are any of your family members actively serving in the military?

Optional - Ethnic/racial identification

Rocky Senior Corps is subject to governmental record keeping and reporting requirements. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information is kept confidential.

All qualified applicants will receive consideration for placement without regard to race, religion, color, sex, age, sexual orientation, national origin, marital status, disability or other legally protected status. I understand it is unlawful to retaliate against any person who, or organization that, files a complaint about such discrimination. In addition to filing a complaint against local and state agencies that are responsible for resolving discrimination complaints, you may bring a complaint to the attention of the Corporation for National and Community Service. Contact information is on the Rocky Mountain Development Council, Inc. website. Please visit https://www.rmdc.net/ for more information.


  • Foster Grandparents logo
  • Senior Companions logo
  • Retired Senior Volunteer Program logo
  • Spirit of Service logo
  • Head Start logo
  • Meals on Wheels logo
  • Rocky Mountain Preschool logo
  • Area IV Agency on Aging logo
  • Low Income Energy Assistance Program logo

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