Volunteer Application

Volunteer Application

Please complete the form below to apply for a volunteer position with us.
Full Name*

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Email Address*
Preferred contact:*
Education:(Check Highest Level Completed):
Availability: Please note days/times you are available to volunteer
Please describe any work or other experiences which yo feel have prepared you to be a volunteer in our organization:
Areas of Interest:

Direct Patient CareClerical WorkMusicArtSew/KnitSpecial EventsComputersHousekeepingIce/Snack CartActivitiesLawn CareMaintenance
Emergency Contact Information:
Name
Phone (Day)
Phone (Evening)
Relationship to Volunteer:
References:

(Please provide the names and addresses of three individuals who are non-relatives whom we may contact.)
Reference #1 Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone
Reference # 2 Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone:
Reference #3 Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone:
Complete this section if 18 years or younger
Age:
School:
Community Service?
Sworn Statement

I certify that the information contained in this application is true and complete to the best of my knowledge and acknowledge that any misrepresentation, falsification or omission herein shall be sufficient reason for dismissal or refusal from our Volunteer Program.
Applicant's Signature:
Should be Empty:

Volunteer Application

Emergency Contact Information:

References:

Complete this section if 18 years or younger

Sworn Statement