Volunteer Program Application

City of San Rafael

Applicant Name:

First Name                                     Middle Name                             Last Name 

 

Address                                         2nd Address           

   

City/State  

    

Zip

    

Home Ph                                        Work Ph                                  Mobile Ph

 

Fax#                                             Pager#                                   Email Address

 

Emergency Contact:

Name:                                                                                        Phone:

 

Applicant Information:

Current Employer or School          

 

 

Highest Level of Education     

 

Brief Description of Previous Experience

 

  May be called at work/School         Have own transportation         Have valid driver's license

Age, If under 18: ____________
How did you learn of the Volunteer Program?

 

Previous Volunteer Experience:

 
Interest in a Particular Program or Department:

 

Type of Volunteer Position Desired:

    Short Term       On-going     Available on Call     Only from ___________ to ________

 

Languages ___________________________________ Read Write Speak
(Other Than English) ___________________________________ Read Write Speak
___________________________________ Read Write Speak
Emergency Certifications: ____________________ Date Received:  ____________________
____________________ Date Received:  ____________________
____________________ Date Received:  ____________________

Availability:

Dates/Times/Days Available to Work: _______________________________________________

 
   
Signature _______________________________________ Date______________________

 

 

 

 

Application Program Application continued....                           Page 2

Name:________________________________  

 

Skills Checklist

Please check the item that applies to you

  

Interests Checklist

Please check the item that applies to you
Carpentry                      Art Projects/Education    
Computer Programming     Carpentry/Construction   
CPR/1st Aid                    Cleanup/Beautification     
DART Trained                  Clerical                         
Database Management      Dart Training                  
Desktop Publishing            Database Management     
Engineering                     Desktop Publishing
Event Planning                 Engineering
Fundraising                     Fundraising
Gardening/Landscaping Historic Preservation
Grant Writing Managing Projects
Graphic Arts Planning
Management Planting/Gardening
Photography Police Work
Planning Receptionist/Concierge
Researching Research
Teaching/Tutoring Senior Program
Typing Special Events
Web Design Teaching/Tutoring
Word Processing Word Processing
Writing/Editing Writing/Editing
Other Skills________________ Other________________________