Volunteer Registration

Step 1 of 4

Your Contact Information

Name(Required)

Prefix First Last Suffix

Mailing Address(Required)

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

Home Phone

Cell Phone

Work Phone

Place Of Employment

Emergency Contact

Contact's Phone

Relationship To You

How Did You Hear About Meals On Wheels Plus?

Background Check

A background check will be conducted as part of the Meals On Wheels Volunteer Registration process, prior to contact with clients or client information. A criminal history record will be obtained from the Department of Public Safety. The Texas Health and Human Services Commission (HHSC) Employee Misconduct Registry and the Nurse Aide Registry will also be checked.

Name(Required)

First Middle Last Maiden (If Applicable)

Date Of Birth(Required)

Last 4 Digits Of Social Security #(Required)

Applicant Signature

Leave this blank. You'll sign the printed version upon acceptance into the volunteer program.

Date Signed

Leave this blank. You'll date the printed version upon acceptance into the volunteer program.

Printed Name Of Person Conducting Review

Signature Of Person Conducting Review

Date Of Review

Attach proof that DPS, HHSC Employee Misconduct Registry, and Nurse Aide Registry reviews were conducted.

Interested In Volunteering?

Your Contact Information

Complete This Section If You Are Delivering Meals

Vehicle Information

Second Vehicle Information

Insurance Information

Please Read And Check Each Item

Background Check

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