Application for Volunteer Service

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Personal Information:

Name

Address

City, State

Zip

Home Phone

Cell Phone

Birthdate

How did you hear about our volunteer opportunities?

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Occupation

Occupation Status

Full TimePart TimeRetired

Employer (current or former if retired)

Education/Field of Study

In Emergency, please notify:

Name

Relationship

Address

Home Phone

Cell Phone

Work Phone

Skills/Experience:

Volunteer Experience (e.g., organization, faith community)

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Do you currently serve on any Boards? Have connections with any corporations or businesses?

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Special Skills/Hobbies/Interests

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Language Skills (fluent)

Are you a Veteran or currently serving in the military?

YesNo

If yes, which branch?

Please provide any additional information you feel would be useful.

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References:

Please provide two (2) personal references (not related)

Name

Phone

Relationship

# of Years Known

Name

Phone

Relationship

# of Years Known

Please provide the following information

Have you ever been convicted of a felony?

YesNo

I certify that all the information submitted by me on this application is true and complete. I agree to keep confidential any private information obtained from my volunteer service. If a photograph is taken during my volunteer service, I give permission for Three Crowns Park to use the photographs. I also agree that, as a volunteer, I may be dismissed for any reason at the discretion of Three Crowns Park Volunteer Program Staff.

Signature

Date

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