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This flash presentation roates three images. The first image is three senior women smiling and laughing. The second is a happy senior couple riding their bikes. The third image is a back view of three older gentlemen sitting on a bench taking a moment to rest from the golf game.
Volunteer.
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Volunteer Application
SHIINE.
* Full Name:
* E-Mail Address:
* Mailing Address:
* City, State, Zip:
* Daytime Phone:

Cell Phone:

Employment History:
Dates: From   To
Employer:     Job Title:
Type of Business:
Job Duties:
Dates: From   To
Employer:     Job Title:
Type of Business:
Job Duties:
Volunteer History
Special skills, interest, and hobbies
Are your or any of your immediate family members licensed insurance agents?
Yes     No
If yes, give full name and relationship.
Why do you want to be SHIINE volunteer?
References
Name Relationship Phone Number
   
Do you have a valid South Dakota driver's license?
Yes     No
Have you ever been convicted of a felony?
Yes     No
If yes, please describe what that felony was.
Note: Conviction of a crime will not automatically disqualify an individual from being considered
for a SHIINE volunteer.
I can attend 2 days of training for new volunteers. (Check SHIINE calendar for dates.)
I can attend an annual day of training. (Check SHIINE calendar for dates.)
I am willing to meet with beneficiaries and gather and enter statistical information as required for state reporting? (Annual enrollment period is October 15th to December 7th of each year)
I am willing to refrain from endorsing or recommending an individual insurance company, policy or agent.
I am willing to keep all information confidential.
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