Volunteer Form Draft

Contact Information

First Name*

Last Name*

Email*

Phone*

Work or Cell Phone

Street Address*

City*

State*

Zip/Postal Code*

Emergency Contact

Emergency Contact Name*

Emergency Contact Phone*

Availability

During which hours are you available for volunteer assignments?*

Weekday mornings
Weekday afternoons
Weekday evenings
Weekend mornings
Weekend afternoons
Weekend evenings

How often are you available?*

One day per week
Two days per week
More than two days per week

Which days of the week are you available?*

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Are you able to commit for at least one year?

Yes
No

Background Information

Are you 18 years or older?*

Yes
No

Educational background*

Languages spoken (select all that apply)*

English
Spanish
Other

Language: Other*

Do you have a valid driver's license?*

Yes
No

Have you ever been convicted of a crime?*

(If considered as a volunteer, a full background check will be completed)

Yes
No

Have you ever needed to obtain a restraining order against someone?*

Yes
No

Did you ever have a restraining order against you in the past or present?*

Yes
No

If "yes" to any of the three previous questions, please explain and provide dates.*

Skills/Qualifications

Summarize special skills and qualifications you have aquired from your education, employment, previous volunteer work, or through other activities, including hobbies or sports.*

Summarize your previous volunteer experience.*

References

Please provide three professional references.

Reference 1*

Name	Phone	Relationship

Reference 2*

Name	Phone	Relationship

Reference 3*

Name	Phone	Relationship

Affirmation

By clicking "Submit", I attest that all information contained in this application is true. I understand that Women Aware reserves the right to terminate my volunteer status at anytime if the information contained above is found to be false. My submission also indicates my full cooperation in the volunteer application process, including checking references, completing a criminal background check, interview, and completion of 40-hour training (if applicable).

Women Aware