(Fill in the required fields below - Each Required Field is marked with an *)

First Name *	Middle Name	Last Name*
Address Number * IF PO Box leave this blank	Address Name* IF PO Box entered here	2nd Address Line
City*	State*	Zip Code*

Please provide at least one phone or email so we may contact you. Example: "415-555-5555" or "anybody@comcast.net"

Home Phone	Cell Phone	Work Phone
Email Address	Alternate Phone

Emergency Contact:

First and Last Name*	Phone Number*

Applicant Information:

Current Employer or School	Highest Level of Education

Brief Description of Previous Work Experience

May be called at work/school Have own transportation Have valid driver's license under18over17 * Required Entry Under 18? Please Enter Age   I

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  - Dates - From    To (i.e. 1/1/06 or 12/31/06)

On-Going  - Start Date (i.e. 1/1/06 or 12/31/06)

Available on Call

Languages (other than English)

Spanish Read Speak Write All      Vietnamese Read Speak Write All Other Read Speak Write All Emergency Certifications: (If not sure of exact date, just give an approximation.)

DART & CERT Date Received: (i.e. 1/1/06 or 12/31/06) EVC Date Received: (i.e. 1/1/06 or 12/31/06) Other1 Date Received: (i.e. 1/1/06 or 12/31/06) Other2 Date Received: (i.e. 1/1/06 or 12/31/06) Willing to be called for service during an emergency? Availability (Days, Times, or Dates) Available to Work: Mondays Mornings Afternoons Evenings Anytime Tuesdays Mornings Afternoons Evenings Anytime Wednesdays Mornings Afternoons Evenings Anytime Thursdays Mornings Afternoons Evenings Anytime Fridays Mornings Afternoons Evenings Anytime Saturdays Mornings Afternoons Evenings Anytime Sundays Mornings Afternoons Evenings Anytime Anytime Mornings Afternoons Evenings Anytime

Is this for community service for traffic or court diversion?

YesNo

*

If so, please enter the offense/violation, e.g., "traffic ticket" or "misdemeanor, drugs", etc.

Signature (Leave Blank - You will be asked to sign at the interview)


Date (i.e. 1/1/06 or 12/31/06)
 

Skills Checklists	Check Items that Apply		Interest Checklist
Carpentry			Art Projects/Education
Computer Programming			Carpentry/Construction
CPR/1st Aid			Cleanup/Beautification
DART Trained			Clerical
Database Management			Concierge
Desktop Publishing			DART Training
Engineering			Database Management
Event Planning			Desktop Publishing
Fundraising			Engineering
Gardening/Landscaping			Fundraising
Grant Writing			Historic Preservation
Graphic Arts			Library Services
Management			Managing Projects
Marketing			Marketing
Photography			Planning
Planning			Planting/Gardening
Researching			Police Work
Teaching/Tutoring			Receptionist
Typing			Research
Web Design			Senior Program
Word Processing			Special Events
Writing/Editing			Teaching/Tutoring
Other:			Word Processing
			Writing/Editing
			Other:

Thank you for volunteering