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Meals on Wheels Volunteer Application

  1. 65 Mount Hope Road Rockaway, NJ 07866

  2. Joseph S. Fiorilla, Director

  3. Peter N. Tabbot, Health Officer / R.E.H.S

  4. Please indicate the Route you would like to deliver:

    Meals on Wheels delivers hot meals to individuals along two routes in Rockaway Township. Please note these are general areas, and may change.

  5. Have you ever been convicted of a crime other than a minor traffic violation?

  6. Have you ever been convicted of driving under the influence?

  7. Are you currently required to register with a law enforcement agency under Megan’s Law?

  8. Signature*

    I certify that the information provided by me is true and accurate to the best of my knowledge. I understand that if any such information is willfully false, I am subject punishment. I further understand that falsification of this application and content herein may result in dismissal as a volunteer from Rockaway Township programs. I authorize Rockaway Township to investigate all statements contained in this application. I acknowledge that if I drive my own vehicle on behalf of Rockaway Township, I will always maintain in force adequate automobile insurance; and I also understand that as a volunteer driver, the limits and coverages provided by my personal automobile insurance are applicable to any accidents or incidents that involve my vehicle, including those that occur while I am serving as a volunteer driver for Rockaway Township.

  9. Leave This Blank:

  10. This field is not part of the form submission.