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Volunteer Application

 
Contact Information:
  Contact information. Required fields are marked with an asterisk.

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Name:

 

 

 

 

       

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City/State/ZIP:

 

    

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Date of Birth:

 

 

What's this?

 
Employment Information:
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(Maximum response 255 chars, approx. 5 rows of text)

 
Name of friends and/or relatives employed or volunteering at Easter Seals TriState:
 


Friend / Relative #1:

   


   


   


 


Friend / Relative #2:

   


   


   


 
Education:
   


 


   


 


   


 


 

(Maximum response 255 chars, approx. 5 rows of text)

 
Personal references:
 


Reference #1:

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Reference #2:

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Volunteer Experience:

(List current or previous volunteer activities you have been involved with)
 


Volunteer Program #1

   


 

(Maximum response 255 chars, approx. 5 rows of text)

 

(Maximum response 255 chars, approx. 5 rows of text)

 


Volunteer Program #2

   


 

(Maximum response 255 chars, approx. 5 rows of text)

 

(Maximum response 255 chars, approx. 5 rows of text)

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(Maximum response 255 chars, approx. 5 rows of text)

 

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Type of Volunteer Assignment Preferred: (Check one)



 

(Maximum response 255 chars, approx. 5 rows of text)

 

Volunteer Assignments: 
Shift schedules are normally based on a four-hour consecutive assignment. Volunteer assignments can start as early as 8 a.m. Assignment start times vary by departments and are available throughout the day and into the evening. Evening and weekend volunteer shifts are dependent upon events that are planned. Youth volunteer shifts would be between 2:30 and 6 p.m.

Indicate the day or days of the week you are available to volunteer as well as the starting shift schedule you would prefer. If you are flexible in the days of the week and starting time, please place a check in any of the boxes based upon your availability. This information will help us to determine the possible openings that may be of interest to you when you meet with the Volunteer Services Coordinator.


Please check the Shift Schedule(s) and Day(s) You Are Available to Volunteer:

 
Question - Not Required - Mornings between 8 and 11 a.m.

 
Question - Not Required - Afternoons between 11 a.m. and 3 p.m.

 
Question - Not Required - Late Afternoons between 3 and 5 p.m.

 

Volunteers may assist professionals in providing technical or recreational activities for participants. Please indicate below the skills and/or experiences you possess and would be willing to utilize in volunteering at Easter Seals TriState.

 

 
Question - Not Required - Office and/or Technical Skills

 
Question - Not Required - Creative Skills:

 
Question - Not Required - Other Skills:

 

(Maximum response 255 chars, approx. 5 rows of text)

 

Applicant's Statement

I hereby affirm that the information provided on this application is true and complete to the best of my knowledge and I agree to have any of the statements checked by Easter Seals TriState or its representatives. I understand that providing any false or misleading information or any omissions may disqualify me from further consideration as a volunteer and may result in my immediate termination even if discovered at a later date.

Easter Seals TriState is an equal opportunity organization. Easter Seals TriState does not discriminate on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I authorize representatives of Easter Seals TriState to conduct a thorough investigation of my activities and authorize all references provided in this application, as well as all other individuals, whom the Organization or its representatives may contact, to provide all information they have about me. Furthermore, I agree to cooperate in such investigation, and release from all liability or responsibility of the Organization, all persons and entities acting on its behalf, and all persons and entities requesting or supplying such information.


 

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