Volunteer Application Form

Alliance For Living

154 Board Street
New London, CT 06340
(860) 447-0884

All Alliance For Living volunteers must understand, sign, and abide by the Alliance For Living confidentiality
policy and Volunteer Handbook. Additionally, all volunteers must assist in all Covid-19 measures for the safety
of our clients and staff. Please be aware that a personal interview is required before service can begin.

Personal Information:
Date of Application: ______________________________ Date of Birth: __________________________________

Last Name: _____________________________________ First Name: ___________________________________

Home Address: _____________________________________________________________________________________

City/Town, State, Zip Code: __________________________________________________________________________

Mailing Address (if different): _________________________________________________________________________

Telephone: ___________________________________ Work Phone: _______________________________________

Email Address: _____________________________________________________________________________________

Emergency Contact: (Full Name) _____________________ Telephone: _______________________________________

What is your Relationship to them? ____________________________________________________________________

Do you have a valid driver license? N Y License Number: ______________ State: _________ Exp: ____________
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Alliance For Living
Volunteer Experience:

Have you worked as a volunteer before? N Y Where? ________________________________________________

Describe your volunteerism:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Where did you hear about us? _________________________________________________________________________

Please Check the Volunteer Positions you are Interested in:

o AFL Delivery Driver - Delivery food to our clients that lack transportation, and you will be required to use your
own transportation and must provide proof of insurance.

o AFL Greeter - Greet our visitors with a smile and compassion. Answer phones and provide PPE and sanitation to
our guests. Conduct basic office tasks to help the office flow smoothly.

o AFL Pantry Stocker - Working the food pantry mainly focusing on moving grocery stock, unloading volunteer
boxes, replenishing the grocery shelf inventory, and stock frozen.

o AFL Data Entry - Working with the administration to input data, write thank you letters, assist with operations
and file AFL paperwork.

o AFL SSP Volunteer - SSP is our syringe service program where we provide harm reduction strategies within the
community.

Please briefly describe your experience and qualifications in each position you selected:

__________________________________________________________________________________________

__________________________________________________________________________________________
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Alliance For Living
__________________________________________________________________________________________

Please indicate the days you would like to serve:

Days: MON TUES WEDS THURS FRI

Times: _________________________________________________________________________________________

Work Experience:
Employer: ____________________________________ Job Title: __________________________________________

Dates: ________________________ Duties: ____________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Two Non-Family References:

Name: __________________________________ Phone: ______________________ Relationship:_________________

Name: __________________________________ Phone: ______________________ Relationship: _________________

Please sign to below that everything are true and accurate:

Signature: ________________________________________________ Date: ___________________________________

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Alliance For Living
Witness: _________________________________________________ Date: ____________________________________