Volunteer Application Personal InformationGender*MaleFemaleName* First Middle Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address (if different) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County* Township* Home Phone*Cell Phone*Email* Birth date* MM slash DD slash YYYY Race* White Black Hispanic American Indian or Alaska Native Asian or Pacific Islander Other/Unknown Provide any other name(s) previously used (include aliases, maiden, married or N/A):* Emergency Contact InformationName* First Last Phone*Relationship* AvailabilityHow often would you like to volunteer* Daily Weekly Monthly Are you available on Mondays?* Yes No What time of day are you available on Mondays? (check all that apply)* Mornings Afternoons Evenings Please enter the time you are available on Monday Mornings (HH:MM - HH:MM) Please enter the time you are available on Monday Afternoons (HH:MM - HH:MM) UntitledPlease enter the time you are available on Monday Evenings (HH:MM - HH:MM) Are you available on Tuesdays?* Yes No What time of day are you available on Tuesdays? (check all that apply)* Mornings Afternoon Evening Please enter the time you are available on Tuesday Mornings (HH:MM - HH:MM) Please enter the time you are available on Tuesday Afternoons (HH:MM - HH:MM) Please enter the time you are available on Tuesday Evenings (HH:MM - HH:MM) Are you available on Wednesdays?* Yes No What time of day are you available on Wednesdays? (check all that apply) Mornings Afternoons Evenings Please enter the time you are available on Wednesday Mornings (HH:MM - HH:MM) Please enter the time you are available on Wednesday Afternoons (HH:MM - HH:MM) Please enter the time you are available on Wednesday Evenings (HH:MM - HH:MM) Are you available on Thursdays?* Yes No What time of day are you available on Thursdays? (check all that apply) Mornings Afternoons Evenings Please enter the time you are available on Thursday Mornings (HH:MM - HH:MM) Please enter the time you are available on Thursday Afternoons (HH:MM - HH:MM) Please enter the time you are available on Thursday Evenings (HH:MM - HH:MM) Are you available on Fridays?* Yes No What time of day are you available on Fridays? (check all that apply) Mornings Afternooons Evenings Please enter the time you are available on Friday Mornings (HH:MM - HH:MM) Please enter the time you are available on Friday Afternoons (HH:MM - HH:MM) Please enter the time you are available on Friday Evenings (HH:MM - HH:MM) Community ServiceAre you volunteering to fulfill a requirement for court-ordered community service?* Yes No How many hours do you need to complete?By what date? MM slash DD slash YYYY StudentsAre you a student?* Yes No Are you volunteering to fulfill a requirement for school?* Yes No How many hours do you need to complete?By what date? MM slash DD slash YYYY Employment History:Name of current/most recent employer* Job title and responsibilities*Address of Company You Work For* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number of Company You Work For*Supervisor's Name* First Last May we contact this employer?* Yes No Name of previous employer Job title and responsibilitiesAddress of Previous Employer Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number of Previous EmployerPrevious Employer Supervisor's Name First Last May we contact your previous employer? Yes No Volunteer HistoryName of current/most recent organization/agency* Volunteer role and responsibilities*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Supervisor's Name* First Last May we contact this organization?* Yes No Name of previous organization/agency Volunteer role and responsibilities at previous organization/agencyAddress of previous organization/agency Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone of previous organization/agencyPrevious Organization/Agency Supervisor's Name First Last May we contact this previous organization/agency? Yes No Education and TrainingDo you have any specialized education or training beyond high school (e.g. professional licenses, technical training, etc.)?References (excluding relatives)Reference #1 Name* First Last Reference #1 Phone*Reference #2 Name* First Last Reference #2 Phone*Reference #3 Name* First Last Reference #3 Phone*Driver InformationDo you have a valid driver’s license?* Yes No Do you have valid car insurance?* Yes No AbilitiesDo you require reasonable accommodations in order to perform volunteer services? Yes No Please explainCan you lift up to 25lbs?* Yes No Talents & Interests SurveyThis information will help us get to know you and how you can serve our community better. Participating in this survey does not commit you to a specific role, but helps us to match you to a volunteer opportunity. My talents and interests are (check all that apply):* arts and crafts athletics and sports building and construction cleaning and organizing clerical work communicating computers and technology cooking dancing drama driving and transportation event planning exercise and personal health facilitating groups financial (taxes, insurance, etc.) fundraising gardening & composting listening and discussing maintaining building and grounds marketing and public relations mentoring music photography playing an instrument public speaking recruiting others reading sewing serving food social justice & advocacy singing teaching telephoning visiting others welcoming and hospitality woodworking working with children working with veterans writing other What instrument(s) do you play? Please list talents or abilities you have that are not listed above:I would prefer volunteer work that allows me to work in the following contexts:* alone with one or two other people as part of a small group as part of a large group as a leader At this time, I would prefer to explore volunteer opportunities that require* monthly commitments weekly commitments daily commitments I am a snowbird and winter away from Grayling.* Yes No I want to volunteer because:*PermissionI give permission for Crawford County Commission on Aging to contact references and conduct a criminal record check. I understand that such reports may be obtained annually during my volunteer service* Yes No I authorize the use of my name and photographs/videos for publicity purposes.* Yes No Are you a minor (under 18 year of age)?* Yes No For parents of minors, please review the information filled out in this application and type your name believe to certify all information is true and correct to the best of your knowledge.* Authorization* By checking this box, I hereby certify all information is true and correct to the best of my knowledge. PhoneThis field is for validation purposes and should be left unchanged. Δ