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angelsonwheelsorg@gmail.com | (540) 429-4726

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Volunteer Application Form

Personal information

Multi-line address

Emergency contact information

Current employment

Are you currently employed?
Yes
No

Position details

Would you like to apply for a virtual or in person position?
Virtual
In person
How many hours are you available to work each month?
1-5
5-10
10-15
15-20
20-40
What days are you available to volunteer?

Additional Information

Have you ever been convicted of violation of any laws, traffic, or otherwise?
Yes
No
Do you have a physical condition that may limit your activity?
Yes
No

References

Please list three persons we may call who are NOT family members

Contact 1

Contact 2

Contact 3

Please sign below to certify that the information provided on this application is true and accurate to the best of your knowledge.

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