First name							 
														
								
												
								Last name							 
														
								
												
								Address							 
														
								
												
								City							 
														
								
												
								Zipcode							 
														
								
												
								Email							 
														
								
												
								Phone number							 
														
								
												
								Instagram							 
														
								
												
								Emergency contact first name							 
														
								
												
								Emergency contact last name							 
														
								
												
								Emergency contact phone number							 
														
								
												
								Relation							 
														
								
								
								
												
								If yes, where did you volunteer at?							 
														
								
												
								What type of volunteer work did you do?							 
														
								
												
								How long were you with the organization?							 
														
								
								
												
								What kind of skillset or experience can you bring to Seniors Fight Back?							 
														
								
								
								
								
								
								
								
												
								If yes, please provide details							 
														
								
								
												
								If yes, please provide details							 
														
								
								
					Application Disclaimer 
I certify that all information I have provided in order to apply for and secure volunteer work with Seniors Fight Back is true, complete, and correct.
I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contract and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. 
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant for consideration for employment on any basis prohibited by applicable local, state, or federal law.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.				
								
												
								Please type your full name							 
														
								
								
					
						
															
																										 
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