Volunteer Application

Volunteer Application

Thank you for your interest in volunteering with the International Institute of Los Angeles (IILA)! Please complete this application to the best of your ability. If you need more time, you can save your progress and return later. You will be sent an email with a link to your saved draft. We will contact you after your submission if there is a current suitable volunteer opportunity available. For questions, please contact Marisa Moonilal Montes, IILA Director of Community Engagement, at mmoonilal@iilosangeles.org or 323-224-3800.

Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
YesNo
YesNo
If yes, how many hours are required?
Educational History

Please complete all fields below that apply to you.
High School Name
Location (City, State)
YesNo
College Name
Location (City, State)
YesNo
Other (Please explain)
Employment History

Please complete all fields below that apply to you.
Current Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
Date
Previous Employer 1
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Previous Employer 2
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Previous Employer 3
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date

Previous Volunteer Experience
Experience #1 (Please explain)
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Experience #2 (Please explain)
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Availability & More

Please select all the days and times you are generally available to volunteer

Rows	Morning (9-11am)	Lunchtime (11am-1pm)	Early Afternoon (1-3pm)	Late Afternoon (3-6pm)	Evening (6-9pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Is there anything else we should know about your availability?
Personal contact (word of mouth)Web searchSocial mediaNews article, radio, or other mediaI am a current or former IILA client.Other
Why do you want to volunteer with IILA?*
YesNo
If yes, which language(s) and how would you rate your fluency?
YesNo
If yes, please explain.

References

Please provide at least one professional reference (if applicable) and two personal references.
Reference 1*

First NameLast Name
Years Known*
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2*

First NameLast Name
Years Known*
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3*

First NameLast Name
Years Known*
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Information

Please name three people who may be called in case of an emergency, as well as a physician, medical insurance provider (if applicable), and out-of-state contact.
Contact 1 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship*
Contact 2 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship*
Contact 3 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship*
Physician Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If physician cannot be reached, what action should be taken?*
Medical Insurance Company Name
Plan Subscriber Name

First NameLast Name
Subscriber ID Number
Allergies or other medical limitations
OUT OF STATE CONTACT

In the event of an earthquake, telephone lines in California will likely be jammed. Arrange an out-of-state or out-of-country contact for your family and share their information below. Long distance phone service will probably be restored sooner than local service.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
SAFETY PROCEDURES
I have received and read the International Institute of Los Angeles Safety Procedures.

Please read the statements below before signing and submitting your completed application.

NOTIFICATION & AGREEMENT

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF VOLUNTEER OPPORTUNITIES, OR DISMISSAL FROM VOLUNTEER WORK REGARDLESS OF WHEN OR H0W DISCOVERED.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied by me on this volunteer application.

STATEMENT OF CONFIDENTIALITY

In order to effectively serve all of our clients, all employees of the International Institute of Los Angeles shall maintain STRICT CONFIDENTIALITY with respect to all information about clients including, but not limited to: names, addresses, telephone numbers, records/communication and documents.

In addition, no employee shall use any agency asset, resources or any confidential and privileged or inside information with respect to the agency for the personal or financial gain of the employee or any other person or interest other than those of the Institute.

Breach of confidentiality is a violation of the law which can lead to civil and criminal liability. It is also a violation of ethical conduct which can cause decertification, and loss of license, as well as disciplinary action within the Institute, which may include termination.

I understand that as an employee of the International Institute of Los Angeles, I may have access to confidential and proprietary information. I agree that all confidential information is the sole property of the Institute, and I will maintain all confidential information in strict confidence and not disclose or use it without proper authorization.
Signature
Today's Date

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Volunteer Application

Educational History

Employment History

Previous Volunteer Experience

Availability & More

References

Emergency Contact Information