Please list your employment history for the past 5 years List dates & supervisor
Please list your Volunteer history for the past 5 years List dates & supervisor
Tell us about your education
8
9
10
11
12
13
14
15
16
17
18
Degree(s)
Areas of Study
Will You be receiving academic credit for your volunteer work?
Yes No
Do you have a vehicle or access to transportation?
Are you 18 years of age or over
Yes No
Days Evenings Weekends
When are you available to volunteer?
What skills/experience would you like to share as a volunteer?
What volunteer positions interest you?
Do you have any special requirements or medical conditions that we should be aware of as you volunteer?
If Yes, please describe
Yes No
Criminal History Background
Have you been convicted of a crime other than a minor traffic violation in the past 7 years?
Yes No
If convicted, please list offense(s) and date(s)
(You must report all convictions. If it is determined that they are not related to a volunteer position, you will not be disqualified.)
References
Please list 2 non related references. Please include full name, address, phone number and relationship
I hereby certify that the information on this application is true and complete. My typed/scanned signature authorizes The Children's Home Society to verify any of the information on this application and to secure information deemed necessary from employers and personal references in order to determine my suitability for the volunteer position I am seeking with The Children's Home Society