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Adult Volunteer Application

Please fill out the required fields.

Required fields are marked with * below.

First Name*:
Last Name*:
Date of Birth*:
Address 1*:
Address 2:
City*:
State*:
Zip*:
Country*:
Home Phone Number*:
Email Address*:
Are you presently employed?*:	Yes No
If so, where?*:
Occupation*:
Hours*:
Business Phone Number*:
Please list your previous experience as a volunteer*:
Please list your previous paid employment*:
Please list your education*:
Please list your special training*:
Please list three personal references who are not your relatives.
Reference 1 Name*:
Address*:
Phone*:
Occupation*:
Reference 2 Name*:
Address*:
Phone*:
Occupation*:
Reference 3 Name*:
Address*:
Phone*:
Occupation*:
*Minimum commitment of three months, working at least four hours a week.
Check days preferred:	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Check shift referred:	8 AM - Noon Noon - 4 PM 4 PM - 8 PM 8 PM - 12 AM 12 AM - 4 AM 4 AM - 8 AM Other
In Case of Emergency, Please Notify:
Name*:
Address*:
Phone*:
Relationship*:

By submitting this form, I understand that as a condition of volunteering, I must take and pass a drug screen. I hereby authorize all of my prior employers, the officials of all schools which I have attended or been associated with, any person named above on this application and all public officials, to give any information regarding my employment, abilities, criminal record or any other characteristic whatsoever, whether or not it is on their records. I hereby release all said persons from any and all liability for any damage whatsoever which might result from their revealing or publishing this information.