Application for Volunteer Services First Name: Last Name: Age: Middle Name: Date Of Birth: mm/dd/yy Shirt Size: select Select Size S M L XL XXL XXXL Street Address: State City: Zip/Postal Code: How Long at this address: years/month Work Phone: Email Address: Home Phone: Mobile Phone: Emergency Contact Person: City: Relationship: Street Address: State: Are you currently employed? Are you currently employed? YesNoPart Time: Part Time: YesNo Full-time: Full-time: YesNo If Yes, Name of Company: Education (Years Completed): High School: Other: Name of College (If Applicable): College: Degree: Why are you interested in Volunteer Work: List any special skills, training, abilities or additional languages you speak: Hobbies, special interests: Do you have a preference for a particular type of work? Do you have a preference for a particular type of work? YesNo If yes, what? How did you hear about the Volunteer Program? Can you provide transportation for yourself? Can you provide transportation for yourself? YesNo How many hours are you willing to commit per week? (Note: Minimum of 4 Hours per week) Day AM PM EVE Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday: Have you ever been indicted for a felony? Have you ever been indicted for a felony? YesNo Have you ever been indicted for a misdemeanor? Have you ever been indicted for a misdemeanor? YesNo Have you ever been convicted for a felony? Have you ever been convicted for a felony? YesNoHave you ever been convicted for a misdemeanor? Have you ever been convicted for a misdemeanor? YesNo Physical limitations: Additional comments: I agree to have a background check and take the orientation course offered. Any special request for written acknowledgement of volunteer hours will be honored only after six (6) months, and a minimum of one hundred (100) hours of volunteer service.