Volunteer Application

Please print

First Name................................................................                                                                            Last Name................................................................

Address...................................................................... City/State/Zip.........................................................................

Telephone.................................................................                                                                        Social Security #........................................................

Date of Birth..............................................................                                                             Spouse’s Name...........................................................

Personal Information (please circle correct response):

Gender:            Male                 Female

Physical Limitations:      No     Yes(Please Explain)                                                                

........................................................................................................................................

Education (highest level completed)

Grades 1-5        6-9         11-12       College       Business        Graduate School Technical/Vocational

Former work/occupation .............................................................                                                    

Most recent employer (optional)..................................................

List previous volunteer experience.......................................................................................

Skills (List your skills and indicate proficiency level)         Skilled    Can Teach    Amateur

1. ...............................................................................................................................................

2. ...............................................................................................................................................

3. ...............................................................................................................................................

Languages             Fluent         Read          Write

1.  ......................................................................................

2. ........................................................................................

Volunteer availability: (Circle all applicable)    

Number of Days per week: 12345

Monday         Tuesday         Wednesday        Thursday      Friday      No Preference

Transportation: (How you will get to your assignment)

Public Trans.      Walk      Bus/Van Taxi/Car Svc       Car

In an emergency, notify:

First Name.......................................................                                                                             Last Name.......................................................

Address..............................................................

City/State/Zip...................................................              Telephone.........................................................

Volunteers hereby agree to serve any client who is assigned regardless of race, sex, creed or national origin.

................................................                               ........................................................

 (Signature/Volunteer)                                            (Signature/Staff)            (Date)