Volunteer Application

Volunteer Application

All information in this document is confidential.
First Name:*
Last Name:*
Street Address:*
City:*
State:*
Zip Code:*
Email Address:*
example@example.com
Date of Birth:*

MonthDayYear
Date
Home Phone:
Cell Phone:*
Physical Limitations:*
VOLUNTEER EXPERIENCE
Interests, Skills, Hobbies:
Clubs/Organizations you belong to:
Your Availability:
Hours per week/month:*
Preferred Days:*
Have you volunteered before?*

YesNo
Position:
Describe the work:
Agency:
May we contact the Agency?

YesNo
Phone
Address:
Highest Level of Education:*
School:*
EMPLOYMENT HISTORY
Current Employer:*
Phone:
Address:
Date Employment Began:

MonthDayYear
Date
Job Title:
Name of Supervisor:
May we contact Employer?*

YesNo
Describe Duties:
Does your employer have a community partnership with a nonprofit organization?

YesNo
REFERENCES (Personal or Professional, not a relative)
1. Name:*
Relationship:*
Phone:*
Address:*
2. Name:
Relationship:
Phone:
Address:
IN CASE OF EMERGENCY
1. Name:*
Relationship:*
Phone:*
2. Name:
Relationship:
Phone:
DRIVING INFORMATION

If you volunteer for a position that requires driving, ILADD, Inc. requires a valid driver's license and proof of automobile insurance.
Are you able to use your automobile if the volunteer position requires one?*

YesNo
I agree to provide a valid driver's license number and proof of automobile insurance. I agree to mail or deliver copies of these documents to ILADD, Inc. I will immediately notify my volunteer supervisor if my driver's license is restricted, suspended, revoked or expired.
Insurance Carrier:*
Policy No:*
Drivers license:*
State of Issue:*
Exp Date:*

MonthDayYear
Date
Signature of Applicant:*

Clear
Date:*

MonthDayYear
Date
CONFIDENTIAL INFORMATION
Have you in the past year used illegal or prescription drugs unlawfully?*

YesNo
Have you ever been convicted of a criminal offense, other than a minor traffic offense?*

YesNo
Have you ever been charged with neglect, abuse, assault, or any sexual offense?*

YesNo
Has your driver's license ever been suspended or revoked?*

YesNo
I agree that ILADD, Inc. may verify any of the information provided by me in this Application. I also agree that ILADD, Inc. may conduct a driver's license and motor vehicle record check. I also understand and agree that ILADD, Inc. will conduct a background screening by Barada Associates Inc. in connection with this Application and agree to provide all necessary information to conduct such check.
Signature of Applicant:*

Clear
Date:*

MonthDayYear
Date
PARENTAL CONSENT (To be completed if Applicant is under 18 years of age)

I give my consent for my child, named on page one of this Application, to provide volunteer services to ILADD, Inc. I also give ILADD, Inc. permission to obtain any emergency medical treatment necessary for the safety of my child.
Printed name of Parent/Guardian:*
Signature of Parent/Guardian:*

Clear
Should be Empty: