Volunteer Application

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) ______________________________________________________________________________

______________________________________________________________________________

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.]? ______________________________________________________________________________

______________________________________________________________________________

Why do you want to volunteer at Jackson’s CLASS, Inc.? [Or, What do you want to gain from this volunteer experience?]

______________________________________________________________________________

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.

______________________________________________________________________________

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

______________________________________________________________________________

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 ________________________________________