Volunteer Application

PERSONAL INFORMATION

Name*

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

Volunteer Position Sought*

EDUCATION

Highest Level of Education*

EMPLOYMENT

Are you currently employed?

Yes

Company/Employer*

Position/Title*

Dates of Employment (starting/ending)*

Employer Address*

Would you like us to keep your employer abreast of your volunteer service and achievement?

Yes

SKILLS & EXPERIENCE

Special training, skills, hobbies

Groups, clubs, organizational memberships

Please describe your prior volunteer experience

(include organization names and dates of service)

What experiences have you had that may prepare you to work as a volunteer in the field of ___________________?

[description of field, e.g., domestic violence, child abuse prevention, youth recreation, etc.]

Why do you want to volunteer? [Or, What do you want to gain from this volunteer experience?]*

Have you ever been convicted of a crime?*

Conviction of a crime is not an automatic disqualification for volunteer work.

Yes

If yes, please explain the nature of the crime and the date of the conviction and disposition.*

Do you have a driver's license?*

Yes

Do you have car insurance?*

Yes

Do you have a car available for transporting others?*

Yes

REFERENCES

Please list three people who know you well and can attest to your character, skills, and dependability. Include your current or last employer.*

Click the plus sign to add a new row.

Name/Organization

Relationship to you

Length of relationship

Phone number

I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with CIES (formerly PSSofNC) that is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by CIES. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with CIES or my termination as a volunteer.

Signature Date*

Signature*

Name

This field is for validation purposes and should be left unchanged.

We're In The Business of Changing Lives

PERSONAL INFORMATION

EDUCATION

EMPLOYMENT

SKILLS & EXPERIENCE

REFERENCES