Volunteer Application

Thank you for your interest in volunteering with cureCADASIL Association. Please provide complete information. An incomplete application may affect your consideration for volunteer opportunities. All volunteer applications are reviewed with consideration of current volunteer opportunities. The information you provide will be stored in confidence and your completed form will be held securely and confidentially. Only authorized staff will have access to your information.
Name *

First Name Last Name
Email Address *
example@example.com
Phone Number *

Area Code Phone Number
Are you at least 18 years of age? *

Yes No
Please describe your prior volunteer experience (include organization names and dates of service). *
May we contact the organization(s)? *

Yes No
Volunteer skills. Please describe your assets and how you can help our organization. *
Does your employer have a community or volunteer partnership? *

Yes No
If yes, please identify your employer . *
Please list two references, at least one of which has knowledge of your service or interest as a volunteer; not a relative.
Reference #1 information. Please include name, email, phone and how you know your reference. *
Reference #2 information. Please include name, email, phone and how you know your reference. *
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Have you ever been convicted of a felony? *

Yes No
If yes, please explain the nature of the crime and the date of the conviction and disposition. (Note: Conviction of a crime is not an automatic disqualification for volunteer work, but will be considered with respect to time, circumstances, seriousness and relationship to volunteer responsibilities. Some volunteer positions may require and are conditioned upon satisfactory passing of a background check. If you are selected for one of those assignments, you will be provided with a separate criminal background check authorization form.) *
Please read the following carefully before submitting this application:

By entering my name below, I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with cureCADASIL Association that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by cureCADASIL Association. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with cureCADASIL Association or my termination as a volunteer.

I hereby release all parties from any liability for furnishing this information. Further, I hereby release, without expecting payment, cureCADASIL and their respective employees, officers and agents from any and all liability which may arise from the use of my photo, likeness, and/or experiences as a volunteer with cureCADASIL in any publications, including electronic or audiovisual presentations, news media stories, promotional materials, written articles, videotape and/or photographs. I understand that I can revoke this release any time in writing and that the use of any of my photos or other information authorized by this release will immediately cease.
Signed *

First Name Last Name
Enter the message as it's shown *
cureCADASIL Association is committed to equal opportunity for all persons and all volunteer recruitment decisions will be based on merit, suitability for the role and experience. All volunteer recruitment decisions are made without regard to race, color, age, religion, creed, national origin, ancestry, physical or mental disability, sexual orientation, gender identity, sex, veteran or military status, marital status, genetic information or any other legally recognized protected basis under federal, state or local law. cureCADASIL Association fully endorses a working environment free from discrimination and harassment.
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