Volunteer Application Form- DEC

Volunteer Application

Thank you for applying to volunteer at Disability Empowerment Center! We are looking for volunteers who are passionate about working with people with disabilities. Ideal candidates are 18 years or older, live or work in King County and are open to learning new tasks. We encourage people with disabilities to apply. If you have questions or need help completing this application, please contact Cynthia Coffin: Cynthia@disabilityempowerment.org or
Applicant Information
Name
Today’s Date

MonthDayYear
Date
Mobile/Primary Phone
Format: (000) 000-0000.
Text messages can be received at
Email
example@example.com
Date of Birth
Preferred Pronouns
Do you have a disability?
Residence Address
City
State
ZIP
How did you learn about this opportunity? Check all that apply

Other
Translation/interpretation - I speak/write:
Employment
Employment status
Name of Employer
Does your employer match volunteer hours or financial donations?
Position Interest
Why would you like to volunteer with Disability Empowerment Center?
What are your primary volunteer interests? Check all that apply

Other
Volunteer Application
What are you looking for in your volunteer experience?
What are some skills and experiences that you would like to contribute and/or gain?
Education
Are you currently enrolled in school?
What is your highest level of education?
Area(s) of study
Work and Volunteer Experience

Work Experience (Paid & Volunteer):

Professional Training Experience and Certifications:

Rows	Training Title	Date Completed	Date of Expiration (if applicable)

Availability
When are you available to volunteer? Please check all that apply
What kind of time commitment are you looking for?
Do you have access to reliable transportation while volunteering? Public transit counts as reliable transportation.
References

Work, volunteer, school or personal references (excluding family members or spouse/partners) are acceptable
Name
Email
example@example.com
Relationship
Phone
Format: (000) 000-0000.
Name
Email
example@example.com
Relationship
Phone
Format: (000) 000-0000.
Name
Email
example@example.com
Relationship
Phone
Format: (000) 000-0000.
Emergency Contact(s)

Preferably two local contacts and one out-of-area contact
Name
Relationship
State
Phone
Format: (000) 000-0000.
Name
Relationship
State
Phone
Format: (000) 000-0000.
I certify that the answers given in this application are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application as may be necessary for the purposes of determining an appropriate and satisfactory volunteer position for me, including contacting my references. I understand that this application is not, and is not intended, to be a contract. I understand that false or misleading information provided in my application or interview may result in my not being able to continue as a volunteer with Disability Empowerment Center.
Electronic Signature OR Initial
If you have any questions, please contact Cynthia Coffin at cynthia@disabilityempowerment.org
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Volunteer Application