Adult Volunteer (Samaritan) Application Form
Please complete this form carefully and press the "Submit" button. We will send you confirmation of your application by mail as soon as possible. Thank you!
Education or Special Training
Have you ever been convicted of, or pleaded guilty to, a crime which includes felony or misdemeanor at any time after you turned 16 years of age?
If yes, please describe in detail. (Note: You do not need to disclose sealed or expunged criminal records.A criminal conviction is not an automatic bar to volunteering.
Personal References (not family members)
Areas of Service Preferred
Preferred Days: First choice:
Are you available on the weekends?
Can you be called to substitute?