Today: 5/17/2008

 

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Volunteer with CAP of the Greater Dayton Area
Volunteer your time and services
At CAP, we are always looking for people to help us out through volunteering. The following form will assist us in selecting and assigning volunteer roles, planning, training and collecting data. Please help us to get to know you.

Volunteer with CAP
Information Form
* denotes required field

* YOUR CONTACT INFORMATION 

* Name:

 

* Address:

  
* City:  
* State:  
* Zip:  
* Home Phone:  
* Work Phone:  
* E-mail:  
   

EMERGENCY CONTACT INFORMATION
* Name:  
* Phone:  
* Relationship:  
   

How did you hear about Community Action
Partnership's Volunteer Program?

   

* Please list your Employment or volunteer History for
the last five years (List dates & supervisor)

   
* Tell us about your education: (Check highest grade)

8 9 10 11 12 13
14 15 16 17 18

 

  

Degree/s:

  

Area of study:

  
   

* Will you be receiving academic credit for your volunteer work?
Yes No  
   
* PERSONAL REFERENCES
(please list names of two non related references)
   

* Name:

 

* Address:

  
* City:  
* State:  
* Zip:  
* Phone:  

* Relationship:

  
   

* Name:

 

* Address:

  
* City:  
* State:  
* Zip:  
* Phone:  

* Relationship:

  
   

* Do you have a vehicle or access to transportation?
Yes No
 
   

* Are you age 18 or older?
Yes No
 
   
* When are you interested in volunteering?
Days   Evenings   Weekends
   
* What skills/experience would you like to share as a volunteer?
   
What volunteer Positions interest you?
   
Do you have any experience working with seniors, youth, disabled or diverse populations or financially disadvantaged people?  If yes share your experiences.
   
Do you have any special requirements or medical conditions that we should be aware of as a volunteer?
   
CRIMINAL HISTORY AND BACKGROUND
   
* Within the last seven years have you been convicted of a violation other than a minor traffic offence?
Yes No
 
 
if Convicted please explain the date and nature of offence
(You must report all convictions.  If it is determined that they are not related to a volunteer position, you will not be disqualified.)
   
I herby certify that the information on this application is true and complete.  My typed/scanned signature authorizes Community Action Partnership to verify any of the information on this application and to secure information deemed necessary from employers and personal references in order to determine my suitability for the volunteer position I am seeking with Community Action Partnership.
   

*Signature:

  

*Date:

  
   

     

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