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Volunteer Request

Apply to be a Volunteer

All volunteers must pass Age Well’s background screening process, attend orientation and complete an interview.

Once the signed Volunteer Information form is received, Age Well conducts a background check. This usually takes around 48 hours to be completed. Once the results are received, our volunteer coordinator will contact you for an interview, provide orientation training information, and discuss volunteer opportunities and scheduling.

Additional training is required for the following programs: Meals on Wheels, Respite Support, and State Health Insurance Program.

Please note: this contact form is not for Helpline services or emergencies.
Required fields indicated by asterisk (*).

Step 1 of 3

Confidential Background Check Authorization

I attest that the information contained in this application is correct to the best of my knowledge. I hereby authorize Age Well and its designated agents and representatives to conduct a comprehensive review of my background causing a report to be generated for employment and/or volunteer purposes. I understand that the scope of the report may include, but is not limited to the following areas: Vermont Adult Abuse Registry, Vermont Child Protection Registry, Vermont Criminal Convictions Records, Office of Inspector General (OIG) List of Excluded Individuals & Entities, Vermont Medicaid Excluded Providers List (employees only). In addition, a Vermont Dept. of Motor Vehicles “Driver Record Search” must be performed for all volunteers of Age Well. Age Well and its representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and dates of birth.(Required)

I consent.

Name(Required)

First MI Last

Former Name(s) if any

Association with Age Well(Required)

Volunteer

Other

Last 4 digits of Social Security #(Required)

Hidden

Last 4 digits of Social Security #

Date of Birth(Required)

Place of Birth(Required)

City State / Province / Region

Hidden

Driver’s License #

Driver's License #

Driver's License Expiration Date

State that issued your Drivers' License

Current Address(Required)

Street Address Address Line 2 City/Town State / Province / Region ZIP / Postal Code

Telephone Number(Required)

Signature(Required)

First Last

Date(Required)

Age Well representative requesting this background check

First Last

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Questions about Volunteering?

Just call our Volunteer team at 802-662-5249. Your call will be answered by one of our friendly, professional and certified staff.

Call us

Volunteer Request

Apply to be a Volunteer

Volunteer Information

Emergency Contact Information

Volunteer Confidentiality Agreement

Safety Check Process

Confidential Background Check Authorization

Questions about Volunteering?

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