First Name * Required Middle Name Last Name * Required Address * Required Address 2 City * Required Zip * Required Please enter at least one phone number in this format (123) 456-7891Home Phone Cell Phone Work Phone Email * Required Please choose a login password * Required The following information is used only for reporting aggregate numbers to our fundersFor reporting purposes, your date of birth is important to us. Please enter as mm/dd/yyyy. Day field may be listed as '01'.Birthday * Required Tell us about yourself Select Value Asian Black/African American Caucasian Hawaiian/Pacific Islander Middle Eastern Multi Native American Other Unknown Would Not disclose * RequiredAre you Hispanic or Latino? Select Value No Yes Would Not Disclose * RequiredGender Select Value Transgender Female Transgender Male Other Would Not Disclose Male Female N/A * RequiredPrimary Language Spoken Select Value English Hmong Spanish Other Would Not Disclose * RequiredAre You a Veteran? Select Value Yes No No per staff * RequiredHow did you hear about us? Select Value None 211 Aging and Disability Resource Center (Milwaukee) Aging and Disability Resource Center (Waukesha) Aunt Bertha Board of Directors Community Event Congregation: Newsletter/Bulletins Congregation:Clergy or parish nurse Congregation:Presentation Current Eras Volunteer Drive Give Serve Engagement Hub Eras Staff Member Eras Website Family of Eras Client Fundraising event Grocery Store Harambee Neighborhood Outreach Healthcare Provider Insurance Company Internet Search JustServe.org Milwaukee Interfaith Newspaper/Media NowPow Other Outreach Presentation Points of Light Radio School Social Media United Way Volunteer Center Volunteer Recruitment Campaign VolunteerMatch.org Word of Mouth * Required If selecting Community Event, School, Presentation, or Other, please specify here: Please enter an emergency contact in the text box. Enter the name, relation, address and contact phone number. * Required If you are enrolled as an Eras volunteer, you may be covered by supplementary accident and liability insurance, at no cost to you. Although this is not a substitute for your own insurance coverage, it covers you in case of personal injury to yourself or others while you are working at your assignment. Please designate your beneficiary.Beneficiary Name * Required Beneficiary Phone Number * Required Are you employed outside of your home? Select Value Yes No No per staff If yes, full time or part time Select Value Full Time Part Time Retired? Select Value Yes No No per staff Most recent employer Job Title Are you fulfilling Court Ordered Community Service? Select Value Yes No No per staff Eras provides excess accident and auto liability insurance in addition to your insurance, which may cover you on your way to, during, and from volunteering with Eras. Our funding sources require that we have insurance information on file for ALL volunteers due to liability purposes.Do you drive? Check the box if yes. Select Value Yes No No per staff Do you have access to a reliable car? Check the box if yes. Select Value Yes No No per staff Make - Model - Year of vehicle Auto Insurance Company Auto Policy # Driver's License # State of license issue Do you have any driving restrictions? Select Value Yes No No per staff If yes, what driving restrictions? Community Clubs/Organization Congregation Membership Any additional skills (ex: fluent in another language, hobbies, music, etc.) Please list two non-family referencesReference 1: Name * Required Reference 1: Relationship * Required Reference 1: Phone Number * Required Reference 1: Email * Required Reference 2: Name Reference 2: Relationship Reference 2: Phone Number Reference 2: Email What is your availability? Choose your general availability and you can enter specific times below each day drop downAvailability: Monday Select Value Early Morning Morning Afternoon Evenings All Day Not available Specific availability: Monday Availability: Tuesday Select Value Early Morning Morning Afternoon Evenings All Day Not available Specific availability: Tuesday Availability: Wednesday Select Value Early Morning Morning Afternoon Evenings All Day Not available Specific availability: Wednesday Availability: Thursday Select Value Early Morning Morning Afternoon Evenings All Day Not available Specific availability: Thursday Availability: Friday Select Value Early Morning Morning Afternoon Evenings All Day Not available Specific availability: Friday Availability: Saturday Select Value Early Morning Morning Afternoon Evenings All Day Not available Specific availability: Saturday Availability: Sunday Select Value Early Morning Morning Afternoon Evenings All Day Not available Specific availability: Sunday Any additional information? Eras is a sponsor of the National Service Program, RSVP (Retired and Senior Volunteer Program). RSVP Volunteers focus on unmet needs in Milwaukee County and Waukesha County. By selecting "Yes" I am confirming that I am 55 or older and I agree to be a part of this programI confirm Select Value Yes No No per staff * Required Please click the link below to open the Volunteer Handbook into a separate tab. After reading the handbook, please follow the instructions on the last page under Volunteer Agreement and Receipt of Handbook (Page 29). Eras Volunteer Handbook with Youth Protection Policy Volunteer Agreement: I understand that the information provided above is truthful and accurate to the best of my knowledge and that knowingly providing false information or omitting information will result in denial or termination of volunteer activities and other penalties as provided under the law. I also understand that I am not an employee of Eras Senior Network, it's sponsors, stations, or the Federal Government and agree to serve without compensation. If you are 18 or older: I acknowledge that a criminal and driving background check and sex offender search will be performed to be considered as a volunteer with Eras Senior Network. I agree that any information regarding a client learned through conversations or contained in a client's file is confidential information. No information should be released to anyone (including family members) without proper authorization. Any volunteer that violates the confidentiality of any client will be terminated from volunteering at Eras Senior Network.Volunteer Agreement (Agree/Disagree): Select Value I Agree I do not Agree * RequiredDate of Agreement: * Required Parental/Guardian Consent: I give my consent for my child named above to provide volunteer services to Eras Senior Network.(required if applicant is under 18 years of age)Parental/Guardian Consent (If Applicable, Agree/Disagree): Select Value I Agree I do not Agree Name of Parent/Guardian Agreeing to Consent (If Applicable): Date of Parent/Guardian Consent (If Applicable): Photo Consent: I, hereby give Eras Senior Network specific permission to: publish copyright, distribute and/or display photographic images of me taken throughout my volunteering. I release and discharge Eras Senior Network from any and all liability by virtue of distortion, blurring, alteration, optical illusion and/or use in composite form, whether the same is intentional, or otherwise.Photo Consent (Agree/Disagree): Select Value I Agree I do not Agree * RequiredDate of Photo Consent: * Required Save Please leave this checkbox blank
Please click the link below to open the Volunteer Handbook into a separate tab. After reading the handbook, please follow the instructions on the last page under Volunteer Agreement and Receipt of Handbook (Page 29).
Eras Volunteer Handbook with Youth Protection Policy
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