Volunteer Application Form – Fill Out and Use This PDF

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Volunteer Application

Name of Local Council_____________

City_____________________________

Contact Information

Name ____________________________________________________ Date______________

Home Address ___________________________________________________________

Home Telephone _______________________________________________________________

Business Address ______________________________________________________________

Business Telephone ______________________________ Cell Phone _____________________

E-mail Address ________________________________________________________________

Date of Birth _______________________________ Social Security # (mandatory/not mandatory)

_____________________ Preferred Contact Location:  Home  Work

Valid Driver’s License:  Yes  No

Emergency Information

Special medical needs/conditions ____________________________________________

Emergency procedures (if applicable) _________________________________________

Emergency contact information:

Name _________________________________ Relationship______________________

Home Phone ____________________________ Other Phone______________________

Address_________________________________________________________________

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Education/Experience

Highest level completed_______________________ Institution________________________

Occupation_________________________________________________________________

How did you hear about the Local Council Name?

___________________________________________________________________________

___________________________________________________________________________

Why are you interested in volunteering for the Council?

___________________________________________________________________________

___________________________________________________________________________

Previous volunteer experience(s) – attach additional sheets as needed

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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What other specific skills, experience and/or resources can you offer the Child and Family Resource Council?

Would you be interested in helping out in special events throughout the year? (i.e. Kidz Quiltz, Advocacy Training, Service to Children Awards, etc.)  Yes  No

Do you have proficiency / skill in another language other than English in which you would feel comfortable assisting the local council’s work?  Yes  NO

If so which language(s)?

1.____________________________________________________________

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EQUAL EMPLOYMENT OPPORTUNITY

Note: We are requesting EEO information on a voluntary basis. The purpose of requesting this information

is to monitor our effectiveness in attracting minorities. The information collected is confidential. Please check

how you would designate yourself racially and/or culturally:

Are you of Hispanic origin (This is defined as being a person of Mexican, Puerto Rican, Cuban, South American, or other Spanish Culture or origin, regardless of race)?

_____Yes or _____No

Race:

[ ] Caucasian

[ ] African American

[] Asian or Pacific Islander- a person with origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Republic, and Samoa.

[] Native American or Alaskan Native- A person with origins in any of the original people of North America and who maintains cultural identification through tribal affiliation or community recognition.

[] Multi-Cultural - a person who would classify themselves as more than one of the

above.

References:

Name_______________________________Title/Relationship________________________

Organization Name___________________________________________________________

Address____________________________________________________________________

____________________________________Telephone______________________________

Personal Professional E-mail_______________________________

Name_______________________________Title/Relationship________________________

Organization Name___________________________________________________________

Address____________________________________________________________________

____________________________________Telephone______________________________

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Note: Because of the sensitive nature of our work, we request the following information:

1.Have you ever been convicted of a crime?

Yes  No

Please explain when, where and the nature of the offense below:

2.Are there any criminal charges, against you currently?

Yes  No

Please explain when, where and the nature of the offense below:

3.Have you ever had a personal protection order against you?

Yes  No

Please explain when, where and the nature of the offense below:

4.Have you ever been involved in the abuse or neglect of a child or adult?

Yes No

Please explain when, where and the nature of the offense below:

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5.Have you ever been involved with a protective service agency?

Yes No

Please explain when, where and the nature of the offense below:

APPLICANT’S STATEMENT

The information contained in this application is correct to the best of my knowledge and permission is hereby given for any investigation that may be necessary. I understand that misleading or untruthful information on this application may result in my dismissal from any volunteer job consideration. I authorize any references listed in this application to relay information they may have regarding my character and fitness for work on behalf of children. I release all such references from liability for any damage that may result from furnishing such evaluations to you, and I waive any right that I have to inspect references provided on my behalf.