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(561) 832-0071

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JTBM Adult Volunteer Application

Home/JTBM Adult Volunteer Application

Adult Volunteer Application

Please bring a form of ID (Driver's license) on your first day. You will still need to sign off on our waiver form and our Volunteer Policies, Procedures and Participant Agreement. This will be done at our office. If you are having to do community service through Probation, please bring a copy of your court papers that state you have to do community service.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Date of Birth*
Date Format: MM slash DD slash YYYY
Age*
Please enter a number from 15 to 99.
Gender
- Male
- Female
Occupation
Referred by
May we add you to our email list?
- Yes
- No
May we add you to our mail list?
- Yes
- No
If the above address is not your permanent address please write you permanent address here
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you here to earn a bicycle?*
- Yes
- No
Are you performing court-mandated service?*
- Yes
- No
If so, how many hours of community service do you need to complete?
Are you here at the request of Drug Court?*
- Yes
- No
If so, how many hours do you need to complete here at Jack the Bike Man?
Are you currently a student?
- Yes
- No
If yes, at what school?
What resources or skills would you like to share? Choose all that apply
How would you best describe your bike mechanics experience level?
- Beginning
- Intermediate
- Advanced
- Professional Shop Mechanic
What do you hope to gain from serving as a Jack the Bike Man volunteer and what are some of the reasons you would like to volunteer with us?
How did you hear about Jack the Bike Man? Please check as many as apply
If friend/other, please describe
Would you agree to a Federal Background Check?*
- Yes
- No
Do you grant Jack the Bike Man permission to use your name and image in Jack the Bike Man publications and promotional materials (e.g. Jack the Bike Man website, newsletter, videos, social media, etc.)?*
- Yes, I grant permission
- No, I do not grant permission
- OR, I grant limited permission
If limited permission, please specify
You are not required to answer the following questions, by your response will help us to better assist you and better assist our community. This information will be kept private and only be used to help us in developing programs and help us in writing grants that will support the day to day operations of Jack the Bike Man, Inc. Thank you for your participation. Please tell us a little about yourself.
Which categories describe you? (select all that apply)
- American Indian or Alaska Native
- Asian
- Black or African American
- Hispanic, Latino, or Spanish origin
- Middle Eastern or North African
- Native Hawaiian or Other Pacific Islander
- White
- Some other race, ethnicity or origin
How long have you lived in Florida? (months)
Please enter a number from 0 to 99.
Do you have any medical issues or disabilities? If so, please explain.
Have you experienced homelessness?
- Yes, Currently
- Yes, In the past
- No
Are you in any type of rehabilitation or half way house for alcohol or substance abuse?
- Yes, Currently
- Yes, in the past
- No
If yes, what is the name of the facility?
What is the address of the facility?
How long have you been sober? (months)
Do you have a car?
- Yes
- No
If you are earning a bike with us, do you plan on using it as your basic means of transportation to and from work?
- Yes
- No

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JTBM Adult Volunteer Application

Adult Volunteer Application