Volunteer Application Applicant InformationPlease tell us a little about yourself.First Name *Last Name *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail *Primary Phone *Cell PhoneDate of BirthGenderEmergency Contact Information[forminator_form id="7464"]First NameLast NameStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePrimary PhoneAlternative PhoneEducational InformationHigh School/GEDNameLocationCourse of StudyLevel CompletedDid you graduate?YesNoVocational SchoolNameLocationCourse of StudyLevel CompletedDid you graduate?YesNoCollege/UniversityNameLocationCourse of StudyLevel CompletedDid you graduate?YesNoSpecial Courses/OtherNameLocationCourse of StudyLevel CompletedDid you graduate?YesNoReferencesPlease list names, relationships and phone number to 3 references.Reference 1 NameRelationshipPhoneReference 2 NameRelationshipPhoneReference 3 NameRelationshipPhoneAdditional InformationDo you have any health problems/ physical disabilities which would prevent you from performing certain kinds of work?YesNoPlease explainhave you served as a volunteer before?YesNoWhere and in what roles have you volunteered?Are you willing to make a 12-month commitment?YesNoHave you been convicted of a crime, other than minor traffic violation(s)?YesNoPlease explainDo you have reliable transportation?YesNoDo you have a valid driver's license?YesNoLicense State/NumberBackground ChecksIn order to ensure the safety of volunteers, the victims and the offenders, we use many methods of screening, including criminal background checks.Are you willing to allow us to conduct a thorough background check?YesNoAcknowledgement *By typing my name below, I submit that the statements on this application are true, complete and correct, to the best of my knowledge. I understand that falsification on this application can disqualify me from consideration or can result in dismissal at a later time.First NameLast NameDateSubmit