
Jackson’s Center for Leadership, Advocacy, and Supportive Services, Inc.
Volunteer Application
Application Date ________________
Volunteer Position Sought _______________________________________________________
Name _____________________________________ Date of Birth _______________________
Home Address _________________________________________________________________
Work Phone ___________________Home Phone _____________________________________
(If under 18 years old)
Name of Consenting Adult _________________________ Phone Number _________________
EDUCATION
Highest Level of Education ________________________________________________________
EMPLOYMENT
Current Employer, if applicable:
Position/Title __________________________________________________________________
Dates of Employment (starting, ending) _______________________________________________
Company/Employer _____________________________________________________________
Address _______________________________________________________________________
Would you like us to keep your employer of your volunteer service and achievement? No Yes
SKILLS & EXPERIENCE
Special training, skills, hobbies _____________________________________________________
Groups, clubs, organizational memberships ___________________________________________
Please describe your prior volunteer experience (include organization names and dates of service) ______________________________________________________________________________
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What experiences have you had that may prepare you to work as a volunteer in the field of [description of field, e.g., homelessness, domestic violence, youth recreation, etc.]? ______________________________________________________________________________
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Why do you want to volunteer at Jackson’s CLASS, Inc.? [Or, What do you want to gain from this volunteer experience?]
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Have you ever been convicted of a crime? [If yes, please explain the nature of the crime and the date of the conviction and disposition.] Conviction of a crime is not an automatic disqualification for volunteer work.
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Do you have a valid Massachusetts ID or driver’s license? No Yes
Do you have car insurance? No Yes
Do you have a reliable vehicle? No 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. Include Name/Organization, Relationship to you, Length of relationship, and Phone number
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Please read the following carefully before signing this application:
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 Jackson’s Center for Leadership, Advocacy, and Supportive Services, Inc. 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 Jackson’s Center for Leadership, Advocacy, and Supportive Services, Inc. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Jackson’s Center for Leadership, Advocacy, and Supportive Services, Inc. or my termination as a volunteer.
Signature __________________________________________ Date _________
Signature of consenting adult ________________________________________