APPLICATION FOR VOLUNTEER
PERSONAL INFORMATION
Name: ______
Address: ______
Street
______
City State Zip
Telephone Number: Cell: ______Work: ______
Email address: ______How often do you check? ______
EDUCATIONAL BACKGROUND:
High School __ Some College __ College Degree __ Graduate Degree __ Professional School __
EMPLOYMENT - If you are not currently employed, please list your past work history, the school you currently attend, or tell us how you spend your free time. Please list your most current experience first.
Position (or year in school): ______Employer (or school): ______
Address: ______Phone: ______
Supervisor or Teacher/Professor: ______
Position (or year in school): ______Employer (or school): ______
Address: ______Phone: ______
Supervisor or Teacher/Professor: ______
Position (or year in school): ______Employer (or school): ______
Address: ______Phone: ______
Supervisor or Teacher/Professor: ______
VOLUNTEER HISTORY (within past five years)
Agency: ______Position:______
Contact Name and Phone Number:______
Agency: ______Position:______
Contact Name and Phone Number:______
REFERENCE CHECK :
Have you ever been convicted of a crime in the US. _____ Yes ___ No
If Yes, please explain and provide details on a separate sheet of paper.
Have you ever had a allegation of child abuse substantiated or founded by any state’s Child Protective Services.
_____ Yes ____ No
If Yes, please explain and provide details on a separate sheet of paper.
Please supply the names and telephone numbers of two individuals who will act as a reference for you: (Church, Civic Group, Employer, Personal)
Contact Name:______ Day Telephone: ______
In what capacity does this individual know you: ______
Number of years this person has known you: ______
Contact Name:______ Day Telephone: ______
In what capacity does this individual know you: ______
Number of years this person has known you: ______
COMMITMENT AVAILABILITY:
Beginning Date: ______Days of Week ______Hours of Day:______
VOLUNTEER INTERESTS - Check areas which interest you.
____ Community Outreach _____ Education Events
____ Fundraising _____ Other: ______
Describe
______
Volunteer Applicant’s Signature Date
* If applicant is under 18: *
I give permission for ______to serve as a volunteer for Ginnie’s House.
______
Parent/Guardian Signature Date