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| Name |
Current Address |
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| Title: |
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Street: |
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| First Name: |
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City: |
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| Middle Name: |
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State: |
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| Last Name: |
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Zip Code: |
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| Phone Numbers |
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| Day Phone #: |
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Night Phone #: |
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| Fax #: |
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Pager #: |
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| Email Address: |
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| Emergency Contact Information |
| (Highest level achieved) |
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| Name: |
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Relationship: |
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| Phone #: |
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| Education |
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| High School: |
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Degree Received: |
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| College: |
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Degree Received: |
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| Major Field: |
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Name of Institution: |
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| Practicums/Internships |
| (Complete this section if you are volunteering as part of academic requirements) |
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| Institution: |
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Course Name: |
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| Instructior: |
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Course Number: |
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| Hours Required: |
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Course Section: |
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| Referral Source |
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Radio/TV |
Employer |
Newspaper |
Recruiting Event |
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Self Inquiry |
Civic/Serv. Group |
Teacher/Counselor |
Friend |
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Church/Temple |
Poster/Flyers |
Other: |
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| Volunteer Experience |
Professional/Civic Membership |
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| Organization: |
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Organization: |
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| Role In Organization: |
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Role In Organization: |
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| Current Employment |
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| Employer: |
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City/State: |
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| Phone Number: |
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Date of Employment: |
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| May we contact you at work regarding your volunteer activity? |
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| Special Skills/Interest |
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Language |
Please specify: |
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Clerical or Computers (programs/programming) |
Please specify: |
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Entertainment |
Please specify: |
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Other Interests |
Please specify: |
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| Personal Objectives |
| (In a brief paragraph, describe the five (5) personal objectives you wish to accomplish while volunteering) |
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| Availability |
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Sunday |
Monday
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Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
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| Hours |
Start |
End |
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| References |
| (List 2 people outside your family) |
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| Name: |
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Name: |
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| Address: |
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Address: |
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| Relationship: |
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Relationship: |
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Phone #: |
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| Have you ever been convicted of a crime? |
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| If yes, please give date, place, charge and disposition of conviction |
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| Are there any felony charges outstanding? |
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| If yes, please give date, place, charge and current status |
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| Are you volunteering to satisfy a court required community service? |
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| If yes, please list your probation officer's name and phone number |
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I certify that the responses on this document are true to the best of my knowledge. I agree that this information may be verified and references contacted by DMC Volunteer Services. Misrepresentation of facts constitutes cause for separation from Volunteer Services. |
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I agree to the above terms
I do not agree to the above terms |
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The DMC is an equal opportunity organization and will not unlawfully discriminate on the basis of race, color, sex, religion, national origin, age, height, weight, marital or veteran status, or the presence of a medical condition or handicap. Michigan and Federal law require employers to make accommodations to handicapped applicants and volunteers, if the handicap can be accommodated with certain guidelines, and the individual can perform the essential job duties with our without such accommodations. Handicapped volunteers and applicants may request an accommodation of their handicap by notifying the organization in writing of the need for accommodations within 182 days of the date the handicapper knows or should know that an accommodation is needed. Failure to properly notify the firm with preclude any claim that the employer failed to accommodate the handicapper. |
Volunteer Application
