VolunteeR APplication

This application does not discriminate in securing volunteers on the basis of race, color, religious creed, national origin, sex, or ancestry; or on the basis of age against persons whose age is over 40 or on the basis of handicap or disability and any other characteristic required by law. No question on this form is interested to secure information to be used for such discrimination.

First Name

Last Name

Date of Birth

Social Security # (if under 18, type all zeros)

Phone

Address

Comments

Have you volunteered before?

Yes

If so, where?

When are you available to volunteer? (Dates & times)

Have you ever been convicted of any criminal offense other than the following: Minor Traffic Violation Fine $500.00 or less; or offenses settled in juvenile court or under welfare youth offender law.

Yes

If yes, please explain ...

Do you consent to a criminal background check?

Yes

Do you have a valid drivers license? (when driving is required)

Yes

Emergency Contact Name

Relationship

Emergency Contact Phone Number

Thank you for applying to volunteer. We will be in touch soon!