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AARP Volunteer Application

Thank you for your interest in volunteering!

At this time, we are not accepting new applications.

40 Courtland St, NE
Atlanta, GA 30303

404.527.7200

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990 Public Disclosure | FY 2023 Financial Statement | Privacy Policy | Diversity, Equity and Inclusion Statement

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Step 1 of 8

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Personal Information

Name*

First Middle Last

Date of birth*

MM slash DD slash YYYY

Email address*

Preferred phone number*

Other phone number

Address*

Street Address Address Line 2 City State ZIP Code

How did you hear about the volunteer opportunity?

United Way of Greater Atlanta

DeKalb Human Services

AARP State Office

Other

Languages

Primary language spoken

Additional languages spoken

How would you describe your fluency with a second language?

Beginning

Some comprehension

Somewhat fluent

Fluent

Education

Highest level of education attained:*

Graduation year*

Subject

School name*

City*

Experience

Include all related job and volunteer experience beginning with the most recent.

Organization

Position

Type of organization

Organization location

City State

Dates of involvement

Hours per week

Reason for leaving

Add another?

Yes

Organization

Position

Type of organization

Organization location

City State

Dates of involvement

Hours per week

Reason for leaving

CRIMINAL CONVICTION/ADJUDICATION

Existence of a criminal conviction may or may not, depending on the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you. You will be required to participate in a criminal background check and fingerprinting. Pending charges may result in a delay of application processing or disqualification.

Have you ever been convicted of a crime?

Yes

No

If "yes", date

MM slash DD slash YYYY

If "yes", location

City State

Charge

Action taken

Certification

Consent*

I hereby consent to permit AARP Foundation Experience Corps to contact anyone it deems appropriate to investigate or verify any information provided to me to discuss my suitability for a volunteer position, including my background, volunteer experience, education, or related matters. I expressly give my consent to any discussions regarding the foregoing and I voluntarily and knowingly waive all rights to bring an action for defamation, invasion of privacy, or similar cause of action, against anyone proving such information. I hereby authorize any organization affiliated with AARP Foundation Experience Corps to investigate my background as necessary for the consideration of my application for a volunteer position. I further authorize all persons, schools, companies, organizations, and law enforcement agencies to supply all information concerning my background and to furnish reports thereon and I hereby release them and any organization affiliated with AARP Foundation Experience Corps from any and all liability and responsibility arising from their doing so. I certify that the answers given by me to all questions on this application and any attachments are, to the best of my knowledge and belief, true and correct and that I have not knowingly withheld any pertinent facts or circumstances. I understand that any omission or misrepresentation of fact in this application may result in refusal of or separation from volunteer service upon discovery thereof.

Sign here

Date

MM slash DD slash YYYY

Citizenship

Some federal programs require participants to meet certain eligibility requirements, which may include proof of U.S. citizenship.

U.S. Citizenship status

U.S. Citizen

U.S. National

Lawful Permanent Resident Alien

Registration number

Exp. date

Demographic Information (optional)

Experience Corps is committed to the principles of equal opportunity and strictly prohibits discrimination on the basis of race, sex, age, religion, national origin, disability, or any other characteristic protected by applicable local or federal law. The following demographic information is being solicited for record keeping purposes only and will not be a factor in selection.

Gender

Male

Female

Other

Ethnic background

Please check the box that best describes your racial or ethnic origins

American Indian or Native Alaskan

Latino/Hispanic

Caucasian (Non-Hispanic)

Native Hawaiian or Other Pacific Islander

West Indian

Multi-Racial

Black or African American

African

Other

Marital status

Married

Separated

Divorced

Widowed

Living with partner

Never married

Schedule

Availability

We ask that you are available for two days out of the week for 2 hours each day, times could vary by location. Please indicate the two days that you are available to volunteer.

Monday

Tuesday

Wednesday

Thursday

AMERICORPS SERVICE

Have you previously served in AmeriCorps?

Yes

No

If "yes", which program?

AmeriCorps VISTA

AmeriCorps NCCC

AmeriCorps State and National Program

Check all that apply.

City/State of service

Date of service

Did you complete your term of service?

Yes

No

If "no", why not?

Please list any additional skills or experiences pertinent to the duties of AARP Experience Corps volunteer here.

Tell us why you are interested in volunteering with this program.

REFERENCES

Applicant is responsible for submitting two references. References CANNOT be related to or relatives of applicant. We will either call each reference you list below or email them a reference form. Admission into the program is contingent upon both reference checks being completed.

Reference 1 - Name

Reference 1 - Relationship

Reference 1 - Phone number

Reference 1 - Email address

Reference 2 - Name

Reference 2 - Relationship

Reference 2 - Phone number

Reference 2 - Email address

I acknowledge that all information provided will be shared with Dekalb County Human Services.*

Yes

Comments

This field is for validation purposes and should be left unchanged.

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