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VOLUNTEER APPLICATION FORM

PERSONAL INFORMATION *Indicates Compulsory Field
Name * :  
Address * :
City *: Parish/State *:
Country *: Postal Code*:
Phone *: (h)
(w)* (c)*
E-mail * :  
Emergency Contact Person * : Phone*:
 
SKILLS AND INTEREST
1. Education*:
2. Current Occupation*:
3. Hobbies, skills, interest*:
4. Languages spoken*:
5. Previous Volunteer experience*:
 
PREFERENCES IN VOLUNTEERING
1. Is there a particular type of volunteer work in which you are interested? (Please check all that apply)*
Working one-on-one with a single participant Working occasionally on group projects
Working directly with a staff person as a assistant Providing service to several participants
Helping around the office in general administrative duties Doing public speaking, fundraising, etc
Doing research, training or focused on an individual project No preference
Other  
Explain :
2. Is there a person or group with whom you are particularly interested in working? (Check all that apply)*
No preference Adults Seniors
Teens Children People with Disabilities
Organisation Staff Males Females
No animals Other  
3. Are there any groups you feel uncomfortable working with?*
  No   Yes  
Explain :
 
AVAILABILITY
1. At what times are you interested in volunteering?*
Flexible Prefer weekdays Prefer evenings
Prefer weekends Prefer days Other
Explain :
2. Do you have a geographic preference as to where you do volunteer work?*
  Yes   No  
Explain* :
3. Do you have own or have access to an automobile you can use for volunteer work?*
  Yes, I own an automobile   No, I do not own an automobile
  Yes, I have access to an automobile   No, I do not have access to an automobile
Explain :
4. Do you have a valid Driver's License?*
  Yes   No  
Explain :
 
BACKGROUND VERIFICATION
1. Have you ever been convicted of a criminal offence?*
  Yes   No
2. Do you have any physical limitations or conditions that might limit your ability to perform certain types of work?*
  Yes   No
If Yes please explain :
3. Please list two non-family references who can be contacted?*
a: Phone
b: Phone
4. How did you learn about us?*
Job description Advertisement Volunteer Organisation
Participant of Organisation Referral by a friend/volunteer Organisation/school
Other
5. Is there any other information you may wish to offer that might affect your placement?*
  Yes   No
If yes please explain :
 
FOR OFFICE USE ONLY
Date application received Data Input
Interview Scheduled Orientation Scheduled
 
   
 
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