Interested in Volunteering? Please complete our online application to sign up today! Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20182019 First Name * Last Name * Street Address City and State Zip Code Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Home Phone Work Phone Cell Phone * Cell Phone Provider So, that we can text you in case of emergency or for your route reminder. Email Preferred Contact SelectHome PhoneWork PhoneCell PhoneEmail Would you like a reminder text or call? SelectYesNo Preferred Reminder Contact Text Email Phone Call N/A Your mobile carrier's message and data rates may apply Employer Can we call you at Work? SelectYesNoN/A Emergency Contact First Name Emergency Contact Last Name Emergency Contact Relationship Emergency Contact Phone Number Driver's License Number State Issued - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Expiration Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20182019202020212022202320242025202620272028 Date Issued Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Auto Insurance Company Insurance information is required. A copy of your insurance card and valid driver's license will be need to be provided to MOWJEC. Volunteer Locations Please select any communities/delivery areas you prefer. To choose multiple options, hold the Ctrl button while selecting. AlvaradoBurlesonCleburneGodleyGrandviewJoshuaLillianRio VistaVenusAvalonBardwellBristolEnnisFerrisItalyMaypearlMidlothianMilfordOvillaPalmerRed OakRockettSardisWaxahachie Delivery Availability Please check the days you are interested in volunteering. This does not commit you to a specific day, but allows us to know when you are available. Monday Tuesday Wednesday Thursday Friday Saturday - AniMeals (Once a Month) Frequency of Availability Once a week Two times a month Monthly As Needed Willing to be a fill-in volunteer? SelectYesNo Fill-in volunteers are sometimes needed if a route is open or a volunteer cancellation occurs. Are you bilingual? SelectYesNo Please list languages spoken Are you volunteering with a group, school or company? SelectYesNo Please list organization Will you need verification of volunteer hours? - None -YesNo Notification Needs Please type the names and contact information for any organizations needing notification of your volunteer hours. How did you hear about Meals on Wheels? FamilyBring a Friend WeekFriendCoworkerNewspaperFacebookTwitterInstagramLinked InYouTubeCommunity EventMeals on Wheels WebsiteMeals on Wheels AmericaAnother Nonprofit OrganizationBillboardRadio AdPoster/FlyerAd/Article in PublicationTV Story Name of Friend * List any other professional skills you would like us to know about: Consent for Criminal Background Check I hereby give permission for Meals on Wheels of Johnson & Ellis Counties to obtain information relating to my criminal history record through Public Data, an online resource for public records from local, state and federal agencies. The criminal history record, as received from the reporting database, may include arrest and conviction data, as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility for volunteering with this organization. I also understand that as long as I stay a volunteer with this organization, the Criminal Background History Records may be repeated at any time. I understand that I will have an opportunity to review the Criminal History and a procedure is available for clarification, if I dispute the record as received. -Select-YesNo Statement of Confidentiality I understand that while volunteering for Meals on Wheels of Johnson & Ellis Counties I may have access to information and records, which are confidential in nature. I have been advised that I am not to breach the client’s/participant’s privacy nor am I to discuss confidential information with anyone. -Select-YesNo Photo Release I hereby give permission for Meals on Wheels of Johnson & Ellis Counties to use my likeness in a photograph in any and all printed publications, as well as online and video-based materials as approved by Meals on Wheels. I understand that there will be no monetary compensation now or in the future for use of my likeness. I am at least 18 years of age. -Select-YesNoI am under the age of 18 Applicant Agreement * I have agreed to volunteer my services to Meals on Wheels of Johnson & Ellis Counties. I hereby release Meals on Wheels and its officers, directors, employees, and volunteers from any liability for any loss, cost, or damage to me or my property arising out of or in connection with any other volunteer work. I also understand that MOWJEC, will provide a Volunteer Orientation/Training program and my participation is required. In addition, I understand that to complete the volunteer application, I will need to fill out additional required forms and copy of my insurance card and valid driver's license will need to be provided to MOWJEC.