Application for Volunteers and Interns

Application for Volunteers and Interns
Today's Date:*

MonthDayYear
Date
Personal Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Home Phone:*
Cell Phone:*
Why are you interested in volunteering?*

Personal InterestEducational InternshipCommunity Service HoursCourt orderedOther
Age Verification

Over 18 Under 18, with work permit

Age
Have you ever worked or do you currently work for Community Action of Greene County, Inc.*

YesNo
Have you ever received service from Community Action of Greene County, Inc.*

YesNo
Do you have a valid driver's license*

YesNo
License #
State
S.S.#
Experience and Education
What is your educational/training background?*
What is your employment history?*
Have you had any previous experience as a volunteer? If so, with what organizations, andand what kind of work did you do?*
How do you hope to benefit from this experience?*
Availability
Which opportunities do you wish to further explore:*

Thrift StoreFood PantrySeasonal ProgramsFund RaisingDomestic Violence ProgramEventVita Income Tax PreparationOther
How long can you commit to volunteering?*

One timeOccasionallyLong TermNot Sure
What days are you available to volunteer?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What times are you available?*

MorningsAfternoonsEvenings
Hobbies/interests*
Skills you would like to use while volunteering:*
Other languages you speak
Level of language skill

BasicConversationalFluent
Other languages you speak
Level of language skill

BasicConversationalFluent
Do you have any special needs or restrictions we should be aware of?:
Date you can begin service:*

MonthDayYear
Date
Criminal History
All volunteer positions require a Criminal History check. Conviction will not necessarily disqualify you from participating. Have you ever been convicted of a crime in this state or any other jurisdiction?
Criminal History*

YesNo
If yes, please explain.
If the volunteer position you are seeking involves work with children, the elderly, or individuals with disabilities, have you ever been held accountable for abuse, maltreatment or neglect?*

YesNo
If yes, please explain
Have you ever been subjected to a civil protective order for domestic violence or abuse? (we ask that you answer this question only if you are volunteering within the domestic violence program) *

YesNo
If yes, please explain
Please describe in 3 5 sentences why you want to be a volunteer or intern at Community Action of Greene County Inc. Why, at this particular time in your life have you chosen to volunteer with us? What do you hope to gain from being a volunteer?
Please explain
Community Action of Greene County Inc. considers applicants for internships/volunteering without regard to sex, race, age, religion, national origin, veteran or marital status, or any other legally protected status. We provide reasonable accommodation to qualified individuals with disabilities when it would not be an undue hardship. If you need a reasonable accommodation in the pre- placement process, please contact the Volunteer Coordinator.
AUTHORIZATION AND AGREEMENT BY APPLICANT
1. I certify that the facts set for in this volunteer application are true and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation in my application or placement interview may result in the rejection of my application or discharge from the volunteer program. As a volunteer/internship applicant I do hereby authorize CAGC inc. to conduct a criminal background check if required.
Signature of Applicant
Signature of Applicant*

Clear
Date

MonthDayYear
Date
Parent/Guardian Signature (required if less than 18 years of age)

Clear
Date

MonthDayYear
Date
Community Action of Greene County Inc. would like to thank you for expressing interest in volunteering with our agency so that together we can work to achieve progress within our community. We hope to make your volunteer experience as fulfilling as possible. We look forward to the assistance that ou can provide to our programs as well as to those we serve.
Volunteer Reference Check
{name} is applying for a Volunteer/Intern positon with Community Action of Greene County, Inc. and has listed you as a reference. Please assist us returning this completed form to the Volunteer Coordinator.
Reference:
Name:
Title:
Affiliation:
Please describe your relationship with the applicant and the number of years/months you have been acquainted:
What are some of the applicant's greatest strengths?
What are some of the applicant's greatest challenges?
If applicable, would you recommend this person to volunteer with children, young adults, crime victims, elderly, and/or families in poverty?

YesNo
If yes, please explain
Please provide a phone number where we can best reach you:

Area CodePhone Number
Date

MonthDayYear
Date
BELOW FOR HUMAN RESOURCES - APPLICANT DO NOT FILL IN

	Over 18	Under 18, with work permit
Age

	Background check conducted
Yes
No

Human Resources Signature

Clear
Should be Empty:

Application for Volunteers and Interns

Personal Information

Experience and Education

Availability

Criminal History

AUTHORIZATION AND AGREEMENT BY APPLICANT

Signature of Applicant

Volunteer Reference Check

Reference: