Volunteer Application Form

Use this form to apply for volunteer work at Elizabeth Buffum Chace Center. Please fill out the form completely to the best of your ability. There are nine sections.

You will receive a copy of your form upon submitting your application, but you may wish to answer the questions in a word processor in case of any problems while filling out or submitting the form. A paper version of this form is also available upon request.

Required fields are marked with a *.

1. Position
	*Position applying for:		Date:	07/09/2008

2. Basic Information

*First Name:

*Last name:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*Home phone:

e.g. 123-456-7890 or (123) 456-7890.
Please do not enter letters or punctuation other than () or -.

Work phone:

e.g. 123-456-7890 or (123) 456-7890.
Please do not enter letters or punctuation other than () or -.

*Email:

*How long have you lived at your present address?

*Are you over 18?

Yes No

3. Present employment (if applicable)

Employer:

Address 1:

Address 2:

City:

State:

Zip:

Supervisor's name / title:

Position:

Length of employment:

4. Previous Employment

Employer:

Position:

Dates:

Reason
for leaving:

Employer:

Position:

Dates:

Reason
for leaving:

Employer:

Position:

Dates:

Reason
for leaving:

5. Education

School attended:

# of
years:

Year graduated:

Major:

1.

2.

3.

6. Volunteer History

Agency/Organization:

Dates:

Type of Work:

1.

2.

3.

7. References

List two references you have known at least one year, excluding relatives, partners, or roommates.

Name:

Address:

Telephone:
e.g. 123-456-7890

1.

2.

3.

8. Personal Emergency Contact

Name:

Relationship:

Home Phone:

e.g. 123-456-7890

Work phone:

e.g. 123-456-7890

9. Additional Questions

Please answer the following questions.

What days/times are you usually available to volunteer? How many hours per week would you be available?

Do you have transportation?

Yes No

Have you ever been
convicted of a felony?

Yes No

If yes, please explain.

Are you bilingual?

Yes No

If yes, what language(s)?

How did you hear about this volunteer opportunity?

List any skills, interests and/or experiences you have that might be helpful in
your volunteer work:

What do you hope to offer in your volunteer work?

What do you hope to gain from your volunteer work?

Clicking the Submit Application button will submit your application to EBC Center. Please review your answers carefully before pressing the button. You will not be able to edit your answers after submitting your application.

Please press this button only once to avoid submitting duplicate applications.