Volunteer/Employee  Information

Last Name

First

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Date Available

Volunteer ID:

Position Applied for

Admin (  )               Volunteer (  )                Intern (  )            PRN (  )

Are you over 18?

YES 

NO 

Are you in High School or Middle School?

YES 

NO 

Have you ever  Volunteered for this company?

YES 

NO  

If so, when?

Have you ever been convicted of a felony?

YES 

NO 

If yes, explain

Education ( If in High School or middle school see page 2)

High School

Address

From

To

Did you graduate?

YES 

NO 

Degree

College

Address

From

To

Did you graduate?

YES 

NO 

Degree

Other

Address

From

To

Did you graduate?

YES 

NO 

Degree

References

Please list at least two references.

Full Name

Relationship

Company

Phone

(           )

Address

Full Name

Relationship

Company

Phone

(           )

Address

Previous Volunteer sites

Company

Phone

(           )

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES 

NO 

Company

Phone

(         )

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving

school contact information ( for school students only )

School:

PH:

                                   EXT:

Contact Name:

Fax Number:

Contact Email Address:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Volunteer Signauture:____________________________________________________________Date:____________________________