Volunteer Application
Please answer the following questions about your personal history. This information is required to comply with our data entry system. Some questions are asked for placement and will not affect your application status but are essential for a thorough evaluation.
General Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What language(s) do you primarily use?
*
English
Spanish
American Sign Language
French
Arabic
Polish
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship to You
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Vehicle
Do you own a vehicle?
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Yes
No
If you own a vehicle, what is the YEAR, MAKE, and MODEL?
If you own a vehicle, what is the License Plate Number?
If you own a vehicle, do you have insurance?
Yes
No
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Student & Employment Status
Are you currently a student?
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Yes
No
If you are a student, what institution are you studying at?
Are you currently employed?
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Yes
No
If you are currently employed, where do you work and what is your job title?
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Volunteer Requirements
Are you required to complete volunteer hours?
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No
Yes, student organization
Yes, employer requirement
Yes, court ordered
Other
If you have court-ordered community service, explain the nature of the offense (ex: DUI, aggravated battery, property damage, reckless driving, child endangerment, etc.).
If you are required to complete volunteer hours, how many are you required to complete?
What is your general availability for volunteering?
*
An estimate is okay, we understand that schedules are everchanging.
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Background
Please note: answers will not necessarily disqualify a person's eligibility to participate in volunteering. Volunteers are subject to various background checks.
Have you ever been charged with a felony or misdemeanor, including DUI? (This would not include minor traffic violations or a case that has been expunged, sealed, dismissed, erased, or pardoned)
*
Yes
No
If you answered yes, please explain:
Do you have experience working or volunteering with the following populations or fields? (select all that apply)
*
Children
Teenagers
Seniors
Summer Camp
Food Pantry
Event Planning
Fundraising
None of the above
Other
Which program(s) would you like to volunteer with? (Note: volunteer opportunities vary on program availability and candidate qualifications)
*
Youth Mentoring
Senior Services
Food Pantry
Education Facilitation
Fundraising/Events
The Country Store Thrift Shop
Summer Camp
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Character References
Personal References include relatives, friends, roommates, etc. Professional References include supervisors, professors, managers, etc. Reference 3 can be either Professional or Personal.
Personal Reference 1
*
First Name
Last Name
Personal Reference 1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Reference 1 Email
example@example.com
How long have you know Reference 1 and in what capacity?
*
Professional Reference 2
*
First Name
Last Name
Professional Reference 2 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Professional Reference 2 Email
example@example.com
How long have you know Reference 2 and in what capacity?
*
Reference 3
*
First Name
Last Name
Reference 3 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 3 Email
example@example.com
How long have you know Reference 3 and in what capacity?
*
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Submit
By submitting this document, you attest that the information provided is factual.
Signature
*
Submit
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