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Midland Health & Senior Services Volunteer Application

  1. Contact Information

  2. Safety Information

  3. This information used to determine what size Personal Protective Equipment (PPE) to issue, if required.

  4. This information used to determine what size Personal Protective Equipment (PPE) to issue, if required.

  5. Please complete this section to ensure your unique skill set is used to best advantage

  6. Please list any languages you speak or write, including sign language

  7. Please list any skills, experience or abilities that could be of service to the community

  8. Please list applicable professional licenses and / or certifications

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