Volunteer Form
Today's Date
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Month
/
Day
Year
Date
Name
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First Name
Last Name
Email
example@example.com
Which program/s are you interested in volunteering in? *You may choose more than one*
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Good Neighbors (Home Revitalizations)
Good Neighbors Blitz ONLY
Pay It Forward (furniture & appliances)
Blessing Boxes (contactless food pantries)
Other (Please Specify)
If you said "other" above, please specify it in the box below.
Phone Number
Please enter a valid phone number.
What Do You Enjoy Doing or Strengths That You Could Use To Serve?
Are you capable of manual labor or lifting heavy objects?
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Yes
No
Maybe
Are you volunteering for school or other community service hours? (Please bring any paperwork that you are required to have signed.) *
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Yes
No
If So How Many Needed?
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Are you willing to undergo a background check or driving record check if needed for certain duties?
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Yes
No
How did you hear about Servolution Network? *
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Servolution Network helped me in the past
Word-of-mouth/friend/referral
Social media (Facebook, Instagram, etc.)
Local media (TV, newspaper, etc.)
Other
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Demographics
**This does NOT determine eligibility but it helps us GREATLY with Federal and community grants, funding, and accountability. Thank you for your help!**
Are you a Veteran?
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Yes
No
Spouse of a veteran
Gender
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Male
Female
Other
Prefer not to say
Race/Ethnicity
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White (Caucasian)
Black or African-American
Native American or Alaskan Native
Asian
Native Hawaiian or other Pacific islander
Hispanic or Latino
Multiple Races or Ethnicities
Other
Household Income Range
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0-$20,000
$20,000-$40,000
$40,000-$60,000
$60,000-$100,000
Above $100,000
Other
Marital Status
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Married
Widowed
Divorced
Seperated
Never Married
Your Age
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17 or younger
18-25
26-35
36-45
46-60
60 or older
Highest Education Level Achieved
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Less than high school diploma
High school diploma or GED
Some college
Associate's degree
Bachelor's degree
Graduate (Master's or PhD) degree
Employment Data
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Employed, working part time (1-31 hours per week)
Employed, working full time (32 + hours per week)
Unemployed and looking for work
Unemployed and NOT looking for work
Retired
Disabled/not able to work
Do you attend a church?
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Yes
No
No, but I would like to
If yes, what church do you attend?
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Please answer each question
(All volunteers are subject to background checks)
Other Names Used: (Any name used other than the one used at the beginning of this form)
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Driver's License Number
State License was issued
Current Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived at this address?
*
Previous Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long did you live at this address?
Volunteer Signature
*
Parent / Guardian Signature
Heading
Submit
Should be Empty: