Volunteer Application

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Volunteer Application

Asterisks indicate a required field

*Name:

*Address:

*City:

*State:

*Zip:

*Telephone (Daytime):

*Telephone (Evening):

*Email Address:

*Date of Birth:

WEEKLY WORK SCHEDULE:

Please inform the Program Coordinator at least one day in advance if you will not be able to report for your volunteer assignment on any given day.

*Please select your times of availability for volunteering:

WORK EXPERIENCE:

*Occupation:

*Employer:

*Length of time on job:

*Immediate Supervisor:

VOLUNTEER EXPERIENCE:

*Please describe previous volunteer experience. Include the organization(s), location(s) and date(s):

*Why did you choose to volunteer?:

INTERESTS AND SKILLS

We would like to get to know you a little better to enhance your visiting experience. Please select what best fits you.

* I AM:

I LIKE TO:
Cook
Debate Politics
Going for Walks
Go to Art Galleries
Knit / Crochet / Needlepoint
Listen to Music:
Paint / Draw
Play board Games
Play an Instrument:
Sports:
Read:
Shop
Sing
Talk / Listen
Travel
Watch Old Movies / TV
Write Poetry / Stories

*EDUCATIONAL BACKGROUND:

Do you speak any foreign languages?
Yes No
If yes, please list:

Are you allergic or fearful of any pets?
Yes No
If yes, please describe:

Do you have any physical limitations? (Ex. Chronic back pain, poor vision, etc.)
Yes No
If yes, please explain:

*Do you have any record of any arrests, criminal charges or convictions?
Yes No
If yes, please explain:

*REFERENCES:

Please list the names of two people who can vouch for you reputation, character, and responsibility. If you are employed full time, one reference must be your employer.

Reference 1

*Name:

*Address:

*City:

*State:

*Zip:

*Telephone (Daytime):

*Telephone (Evening):

*Relationship:

Reference 2

*Name:

*Address:

*City:

*State:

*Zip:

*Telephone (Daytime):

*Telephone (Evening):

*Relationship:

Statement of Understanding and Consent

I have read the accompanying materials. If I am accepted as a volunteer, I understand I am committing to a minimum six month obligation will fulfill my volunteer responsibilities to the best of my ability. I acknowledge and agree that in the case of extenuating circumstances, I am not obligated to serve as a volunteer.

I further agree to accept the supervision of the appropriate individual(s) at my assigned placement and to discontinue my service if I am requested to do so by the organization.

The Homebound Visitation Program Coordinator will contact my references and may conduct a background check. iVolunteer Island reserves the right to reject a candidate for any reason that the organization, in its sole judgment, determines will or may affect either the best interests of the client or the iVolunteer. Furthermore, iVolunteer reserves the right to withhold the reason(s) for such a refusal.

I understand that once I am assigned to a volunteer placement I will be required to maintain monthly contact with the Homebound Visitation Program Coordinator for the purpose of monitoring and assessing the client/volunteer relationship.

*Signature of Applicant:

*Date:

By printing your name above you are affirming that all of the above information is accurate.

SUBMIT