Volunteer Application

Volunteers

Please fill out our secure online application below or call our special Volunteer line: 910-805-4662 to sign up. After you submit your application we will be in touch with you. Please review the positions on the Volunteer Roles page that our volunteers fill and, when we contact you, we can discuss the opportunities and your interests. We will also give you a password to enter the Volunteers Only section of our site where you can continue the process by completing an online background check.

Please note: if you would like to become a driver, we will ask you to complete a special driver's license check and will need to provide copies of your auto liability and license. You will see the specially-marked sections below.

Thank you for your interest!

Volunteer Application

All Personal Information and Availability fields are required. If you are applying as a volunteer driver please also include those items marked *. Otherwise, you may omit those items.
All information disclosed by you or otherwise obtained by the Program shall be kept confidential by Aging in Place Downtown.

PERSONAL INFORMATION

Name *

First

Last

Email *

Length of Time in Wilmington *

Address *

Date of Birth *

Work Phone *

Home Phone *

Cell Phone *

Occupation *

Emergency Contact *

Phone Number *

Are you able to communicate in a language other than English?

Choose One *

Yes No

If yes, please specify *

Please list two references, unrelated to you, with NAME, EMAIL and PHONE NUMBER *

How did you hear about this program? *

AVAILABILITY

Are there months of the year that you will not be available?

CAR AND DRIVER INFORMATION*

Driver's license number* *

Expiration date* *

State* *

Make and Model of car* *

Choose Any* *

2-Door 4-Door Van wheel chair accessible

Number of passengers car will safely hold* *

Are you willing to drive:*

Select One* *

Are you willing to deliver/escort seniors:*

Choose Any* *

To curb only To the door Inside the destination

Are you willing to walk arm-through-arm or to steady the senior if needed?*

Choose one* *

Yes No

Auto Insurance for vehicle you plan to use:*

Company name* *

Company phone* *

Policy number* *

Bodily Injury limit* *

Property Damage limit* *

You will be asked to upload your policy documents and license below.
If you are unable to upload them, you will be asked to mail or deliver them.

Have you been involved in a car accident in the last five years?*

Choose One* *

Yes No

If yes, please explain the circumstances and state whether you were given a citation: *

Have you received a traffic violation (unrelated to parking) in the past five years?*

Choose One* *

Yes No

If yes, please state the offense for which you were convicted and if your license was suspended or revoked: *

Have you ever been convicted of any type of felony or misdemeanor involving a vehicle?*

Choose One* *

Yes No

If yes, please explain *

Do you have any health or substance use problem that might affect or limit your driving?*

Choose One* *

Yes No

Please explain: *

Agreements, Acknowledgements, and Authorizations:

1. I hereby apply for service as a volunteer. I understand and agree to comply with policies and procedures of the Aging in Place Downtown program, copies of which are available to me at any time upon my request.

2. AIPD will engage Verified Volunteers to conduct a background check including Criminal History and Sex Offender Search. I acknowledge that I have reviewed the following FCRA required FTC prescribed documents (links provided below) pertaining to background checks:

1) Notice to Users of Consumer Reports: Obligations of Users under the FCRA

2) A Summary of Your Rights under the Fair Credit Reporting Act

3) Remedying the Effects of Identity Theft

4) Disposal of Consumer Report Information and Records.

3. By submitting this application, I state that I have read and agree to the notices listed above and, if I am applying as a driver, authorize the NC Department of Motor Vehicles, or other similar agency, to furnish any and all documents and electronic information that it has with respect to my driving history and records, including but not limited to any and all violations of law, to AIPD as requested by AIPD from time to time. This authorization shall remain in effect until revoked by me in writing or as limited by applicable state law.

If you are applying as a driver, please upload a copy of your auto liability
coverage (declaration page of your policy) as well as a copy of your driver’s license.

Upload File *

Max file size: 20MB

You have the right to certain explanations about our application and background check process. Information and links are provided below for your convenience. You can review them now or at any time. They are not necessary for submitting your application.

When you have completed your application (above) please
click on the SUBMIT button at the bottom of this page.

Insurance. All volunteers are covered by AIPD’s volunteer insurance policy that offers personal injury and liability coverage. The details can be found here: http://www.cimaworld.com/~cima/wp-content/uploads/2012/07/TermsAndConditions.pdf

Note that only volunteers who drive for AIPD in their own vehicles are covered by the portions pertaining to auto liability and injury as stated below.

**Insurance. All volunteers operating personal vehicles (not owned or leased by Aging in Place Downtown) for the business of AIPD, become additional insureds under AIPD’s auto liability policy, but only:

• In excess of the volunteer’s personal auto liability coverage and policy limits

• To the extent of bodily injuries to third parties and/or physical damage to third-party vehicles or property of others.

**Aging in Place Downtown’s automobile insurance policy does not cover bodily injury to the volunteer or physical damage to the volunteer’s vehicle. The volunteer is required to maintain minimum required auto liability limits as mandated by the State of North Carolina.

AIPD further suggests that volunteers:

• Maintain third-party liability limits of at least $100,000 per person bodily injury, $300,000 per accident, and $100,000 property damage

• Add uninsured/underinsured motorists coverage to their policy

• Obtain physical damage coverage for their vehicle

• Maintain personal medical insurance or, through their auto policy, purchase medical payments coverage or personal injury protection to ensure bodily injury protection for themselves.

Reservation of Right of Refusal. I realize that AIPD, in its sole discretion, reserves the right to refuse the offer of services of any potential volunteer. Notwithstanding the foregoing, I understand that this refusal shall not be based upon any criteria that would violate either state or federal law, including, but not limited to, color, race, religion, national origin, age, sexual orientation, or any other protected classification.

Background Check. AIPD will engage Verified Volunteers to conduct a background check including Criminal History and Sex Offender Search. Each link below contains important information that is required by the Fair Credit Reporting Act (FCRA) in order to conduct the check. Please review the information provided within each link prior to submitting below.

1. Notice to Users of Consumer Reports: Obligations of Users under the FCRA   http://www.castlebranch.com/pdf/information_center/NoticeToUsersOfConsumerReport s.pdf

2. Summary of Your Rights under the FCRA:
http://www.consumer.ftc.gov/articles/pdf-0096-fair-credit-reporting-act.pdf

3. Remedying the Effects of Identity Theft   http://www.castlebranch.com/pdf/information_center/RemedyingTheEffectsofIdentityTheft.pdf

4. Disposal of Consumer Report Information and Records http://www.castlebranch.com/pdf/information_center/16_CFR_Part_682_disposal.pdf

NOTE: To the best of our knowledge and experience, the above links are from a reliable source and do not transmit a virus to your computer.

Submit

Volunteers