Select a Location* —Please choose an option—AllentownEastonBethlehemForks of EastonFrederickHersheyLancasterMechanicsburgSouth HillsWyomissingYork SouthYork WestGettysburg
First Name*
Last Name*
Are you 14 years or older?* —Please choose an option—YesNo
Contact Preference* —Please choose an option—EmailMailCall
Email*
Street Address*
Apt/Suite/Others
City*
State*
ZIP/Postal Code*
Phone Number*
Interested to volunteer as an individual or group?
IndividualGroup
Do you have any special talents you wish to share with our residents? —Please choose an option—YesNo
What type of activities would you be willing to help with? (List in order of preference)*
Previous Volunteer Experience*
Hours available to work*
Days Available (Check all that apply)
SundayMondayTuesdayWednesdayThursdayFridaySaturday
Do you have any convictions for criminal offense?* —Please choose an option—YesNo
Additional Comments or Message
I certify that the information given in this application is true and complete to the best of my knowledge. I understand that misrepresentation or omission of information provided in my application or interviews may result in discharge, no matter when discovered. I authorize investigation of all statements contained in this application and investigation into my background and references. I release this organization and any other individual or entity from any and all liability, whatsoever, associated with obtaining or releasing information about me. I understand and agree that my volunteer relationship with Country Meadows Retirement Communities may be terminated either by me or by Country Meadows at any time and for any reason, without prior notice to the other party. I certify that I do not have any history of or conviction for a violent crime, moral offenses or of abusing persons, except as noted on this application. I further certify that I was never dismissed from employment due to abuse of clients or residents.* Please check to confirm the above statement. Your privacy is important to us. If you have any questions on how we use the information provided in these forms, please see our Privacy Policy.
