Volunteer Application

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Work Phone

Email*

Previous Volunteer Experience:

Current/Former Employment:

Other Information:

(such as education, general interests/hobbies, languages spoken, etc)

Availability and Volunteer Assignment Preferences*

Mornings (Mon-Fri)
Afternoons (Mon-Fri)
Evenings (Mon-Fri)
Weekends
Once A Week
More Than Once A Week
One Time Only
As Needed

Do You Have a Valid Drivers License?*

Yes
No

Have You Ever Been Convicted For Violation Of Any Laws, Traffic Or Otherwise?*

Yes
No

If Yes, Please explain

Do You Have Any Physical Condition that May Limit Your Activities?*

Yes
No

If Yes, Please explain

Who To Notify In Case Of An Emergency? (Name and #)

References (Name, Relationship, Phone)

Please list three persons we may call who are NOT family, one of whom may be your religious or spiritual leader, teacher, employer or relationship other than a personal friend.