Ontario County, NY - Official Website

General Information

Name:*
Today's date:*
Address:*
Home phone:
Cell phone:
Work phone:
Email:
Date of birth:
Emergency contact:
(Name, phone number, and relationship)
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Volunteering Information

Days you are able to volunteer:
How often:
How did you hear about OFA?
Do you have independent and reliable means of transportation to and from volunteer activities?
1. Yes
2. No
Do you have a valid NYS Driver's License?
1. Yes
2. No
(Please provide a copy of your license and insurance)
List the date(s) and explanation(s) of any driving violations or convictions.
Have you ever been convicted of a crime?
1. Yes
2. No
If yes, please specify:
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Previous Volunteer Experience

Previous volunteer experience with the elderly:
Previous volunteer training:
Have you ever volunteered for OFA before?
1. Yes
2. No
If yes, please explain:
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Volunteer Position Preference

References

Reference instructions:
Please list two references who aren't related to you that we may contact who have knowledge of your qualifications. Please provide a name, complete address, phone number, relationship, and years known for each individual.
1.) Name:
Phone:
Address:
Relationship:
Years known:
2.) Name:
Phone:
Address:
Relationship:
Years known:
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Confidentiality Agreement and Disclaimer

Confidentiality
I understand that as an Ontario County Office for the Aging (OFA) Volunteer I am entrusted with the responsibility of assisting Ontario County Senior Citizens in receiving the services that OFA provides. I understand that whatever knowledge I have as a result of my work as a Volunteer for OFA is to be kept strictly confidential. I am to share such information, as appropriate, with OFA staff only. I, therefore, pledge to keep any and all knowledge pertaining to OFA clients and their families in complete confidence, and in so doing honor them with the respect and dignity to which they are entitled. In addition, I will not discuss my personal views with OFA clients or perform any solicitation.
I understand that as an Ontario County Office for the Aging (OFA) Volunteer I am entrusted with the responsibility of assisting Ontario County Senior Citizens in receiving the services that OFA provides. I understand that whatever knowledge I have as a result of my work as a Volunteer for OFA is to be kept strictly confidential. I am to share such information, as appropriate, with OFA staff only. I, therefore, pledge to keep any and all knowledge pertaining to OFA clients and their families in complete confidence, and in so doing honor them with the respect and dignity to which they are entitled. In addition, I will not discuss my personal views with OFA clients or perform any solicitation.
I affirm that the statements made on this application are true. I understand that misrepresentation or omission of facts requested is cause for my dismissal as an Ontario County Office for the Aging Volunteer.
1. Agree
2. Disagree

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1. Receive an email copy of this form.
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Confidentiality Agreement and Disclaimer

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