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AmeriCorps Seniors
RSVP of Dallas & Collin Counties
Volunteer Membership Application
Sponsored by
Logo
3910 Harry Hines Blvd., Dallas, TX 75219
Phone: (214) 823-5700 
Fax: (214) 826-2441 


Step 1: Your Contact Details










Mailing Address



If not listed and in Texas, choose "Other - Texas." If not in Texas, choose "Out of State."


Step 2: Tell Us About Yourself
Date of Birth (MM/DD/YYYY)
I certify I am 55+ years old
as of the date of this application.
RSVP Volunteers MUST be 55 years or older at the time of enrollment.
What is your ethnicity?
Are you hispanic?
Are you a U.S. Veteran?
Is your spouse a U.S. Veteran?
Do you have an active-duty family
member in the military?
Gender
Step 3: Volunteer Preferences
 
If you were referred by a volunteer or organization, please list their name here.
Do you have an agency of choice?
If yes, which agency?
Do you have a volunteer job preference?
If yes, what volunteer job?
What is your geographical preference
(select all that apply)?
If other, what geographical area?
Please indicate if you speak or write any languages besides English (select all that apply):
If other, what language?
Please list any education,skills,or training you would like to use in your volunteer work: 
Do you have any physical limitations that you want considered prior to a volunteer job placement?
If yes, please list.
About how many hours per month do you currently volunteer?
hours per month
Please enter a number from 0 - 200 with no decimals, letters, or special characters.



Step 4: Background Check

Some (not all) of our partner organizations require a criminal background check. 
 
Is there any reason you may not pass a background check?
If yes, please explain.
What was/is your main occupation?
Who is your current (or previous) employer?
 
Step 5: Emergency Contact
Emergency Contact








Step 6: Supplemental Insurance

ACTIVE VOLUNTEERS ARE PROVIDED FREE SUPPLEMENTAL ACCIDENT INSURANCE FROM RSVP.  THIS INSURANCE PROVIDES COVERAGE WHILE YOU ARE VOLUNTEERING FOR YOUR RSVP VOLUNTEER ASSIGNMENT.  SEE THE ATTACHED INFORMATION SHEET FOR DETAILS.

Supplemental Insurance Beneficiary Information









Please provide your Driver's License details here:






Step 7: Resume


I verify that the above information is accurate and truthful.

Please click Go To eSignature to complete the application.  

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