(310) 695-7030 (310) 695-7030 VOLUNTEER DONATE Home Key Issues Aging Loneliness Transportation About Mission Community Benefits Service Area Team Board Join Media Events Contact COVID-19 Home Key Issues Aging Loneliness Transportation About Mission Community Benefits Service Area Team Board Join Media Events Contact COVID-19 WPV CARES Volunteer COVID-19 WPV Volunteer Application form COVID-19 SSC To be completed by those who wish to volunteer at Westside Pacific Villages, especially for the WPV CARES Emergency Response Program to support older adults during the COVID-19 Public Health Pandemic. Step 1 of 7 14% Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY How would you describe your gender?MaleFemaleNonbinary, Genderqueer, AgenderPrefer Not to AnswerEmail* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell PhoneWork Phone Save and Continue Later How did you hear about Westside Pacific Villages? Please provide the name(s) of anyone who referred you to WPV CARES.*Are you affiliated with one of the partnering organizations? (Select all that apply) Westchester Rotary Westchestery Family YMCA LAX Coastal Chamber Covenant Presbyterian Culver Palms Meals on Wheels Drollinger Family Charitable Foundation Westside Pacific Villages Airport Marina Counseling Service Councilmember Mike Bonin's Office N/A Are you affiliated with another local organization (service club, school, faith-based, other?)Emergency Contact #1:*First NameLast NameRelationshipEmail or Phone (required)Emergency Contact #2:First NameLast NameRelationshipEmail or Phone (required) Save and Continue Later Please indicate your volunteer areas of interest Transportation Computer/technology support: setup email, download pictures, install software, provide training for basic technology. Errands & Deliveries: pickup groceries, prescriptions, etc. and deliver to members. Pet care: taking pets for a walk, grooming, offering transportation to the veterinarian, etc. Skilled Handywork: conduct minor home repair and maintenance inside and outside. Light chores: Helping out with activities around the home. Yardwork/gardening: help clean yard and plant new foliage. Phone Social Support: Call a Neighbor WPV Office Volunteer Opportunities Office Administration: record keeping, data entry, answering phones, developing and updating paperwork, filing, etc. Writing: articles, communications, grants, policy/procedural handbooks, etc. Social media (ncluding content development, photographs, video, editing) Other Interest finderPlease let us know if you have special skills or areas of interest you would like to share. Can you speak another language?*YesNoPlease list the other language(s) belowPlease let us know if you can speak another language. Save and Continue Later Are you volunteering to be a DRIVER?*YesNoDriver's License Number*We will also need a copy of your drivers license. Driver's License Expiration Date* Date Format: MM slash DD slash YYYY Auto Insurance Number*Auto Insurance Expiration Date* Date Format: MM slash DD slash YYYY Vehicle Make/Model*Vehicle Color*Curb level?*YesNoIf SUV, does your vehicle have a running board?YesNo Save and Continue Later Availability*Mon.Tues.Wed.Thurs.Fri.Sat.Sun. Please indicate the times that you are available to volunteer.How many hours do you prefer to volunteer for per week? Save and Continue Later Verification* By selecting this box, I am indicating that I have read, understand, and agree to the following: All volunteers are subject to a background check and a current DMV report. You are required to provide a copy of your Drivers License or DMV Senior ID and proof of your current automobile insurance, with limits of liability clearly indicated. As a volunteer, you are required to attend a Westside Pacific Villages training class. Minor volunteers (age 16-18) require signed approval from a parent or legal guardian. * By selecting this box, I certify that all information in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for volunteer service and may result in my dismissal, if discovered, at a later date. Social Security NumberPlease provide your social security number here or call us to provide via telephone.* By selecting this box, I hereby authorize Westside Pacific Villages, or any designated agent(s) working in their behalf, to obtain and conduct a background check and current DMV report pertaining to me. Save and Continue Later Is the applicant a minor (under the age of 18)?*YesNoName of Applicant*By typing my name below, I hereby agree to all of the statements above.Today's Date*Name of Parent or Legal Guardian*By typing my name below, I hereby agree to all of the statements above.Today's Date*Name of Applicant (minor)*By typing my name below, I hereby agree to all of the statements above.Today's Date*UntitledFirst ChoiceSecond ChoiceThird ChoiceNameThis field is for validation purposes and should be left unchanged. Save and Continue Later Copyright © 2020 Westside Pacific Villages | Website by Spotlight Story Productions, LLC.