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Volunteer Application

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					                      Volunteer Application Form

Name: _________________________________________ Phone: _________________
       Last         First          Middle
Address: _______________________________________________________________
            Street                  City              State       Zip
Email: _________________________________________________________________


How did you hear about Camp Fire USA? ___________________________________
Do you need service hours for a class? ________ If yes, how many hours? ________
For what school and class? ________________________________________________

What days are best for you to volunteer?
  Monday          Tuesday        Wednesday             Thursday       Friday           Weekend
What times are best for you to volunteer?
         7:00 – 12:00pm     12:00 – 3:00pm       3:00 – 6:00pm        6:00 – 10:00pm
With what grade level of children do you prefer to work?
    Pre-K     Kindergarten      First      Second       Third      Fourth      Fifth    Sixth
                               Junior High      High School
With what program are you interested in volunteering?
                   Before-School        After-School     Shelter      Office


Previous Job-Related Experience
Please describe position(s) held and general responsibilites.
As a volunteer:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
As a paid employee: ______________________________________________________
________________________________________________________________________
________________________________________________________________________
                    Volunteer Application Form
Current memberships held (in community, youth or professional organizations):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Education and/or special training (i.e. social work, education, CPR, etc.): ________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Hobbies/interests/skills (i.e. chess, Spanish, soccer, etc.): _______________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Health limitations or considerations: _______________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


In the space below, please comment on your interest in a Camp Fire USA volunteer
position and the contribution you can make through this role: __________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Emergency Contact: _____________________ _______________ ______________
                          Name               Phone         Relationship
                             Volunteer Application Form
References

Please give at least two references (other than relatives):

1. Name: ___________________________________                           Phone: _________________

    Address: ____________________________________________________________


2. Name: ___________________________________                           Phone: _________________

    Address: ____________________________________________________________


3. Name: ___________________________________                           Phone: _________________

    Address: ____________________________________________________________


Do you have a valid driver’s license for your state of residence? ____ Yes ____ No

Have you ever been convicted of child abuse, violation of any law or ordinance
regulating conduct toward minors, or any felony? _____ Yes _____ No

If yes, please explain. ____________________________________________________
_______________________________________________________________________


I certify that the information given herein is true and complete to the best of my
knowledge. I authorize investigations of all statements contained in this application.
I understand that misrepresentation or omission of facts called for herein will be
sufficient cause for cancellation of consideration for appointment or dismissal if I
have been appointed.


______________________________________________                              __________________

       Signature of Applicant                                                  Date


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