Volunteer Form

Thank you for your interest in welcoming our new neighbors, refugees and immigrants to our community!

Please make out our Volunteer Form Below:

Full Name	A value is required.
Street	A value is required.
City	A value is required.
State	A value is required.
Zip Code	A value is required.
Home Phone	A value is required.
Work Phone	A value is required.
Cell Phone	A value is required.
Email	A value is required.Invalid format.
Date of Birth	A value is required.Invalid format.
Social Security #	Invalid format.
Emergency Contact Person	A value is required.
Phone
Employment History Include: Employer, Location, Position, and Dates	A value is required.
Educational History Include School, Field of Study, Degree, and Dates	A value is required.
Volunteer/Internship Experience	A value is required.
Please list any specific qualifications/skills which would be of value to this program:
Specific Interests if known
Have You Ever Been Convicted of a Crime	Please select an item.
If yes, please explain (a conviction does not necessarily bar you from this program
Availability/Schedule List times and days available Monday thru Frday	A value is required Maximum Overall Availability A value is required.hours/week OR hours/month A value is required.
	Dates of Availability: I will be available as of:
Please list three references (eg: supervisors, professors, mentors etc. Include Name, Address, Relationship and Phone	Name	A value is required.
	Address	A value is required.
	Relationship	A value is required.
	Phone	A value is required.
	Name	A value is required.
	Address	A value is required.
	Relationship	A value is required.
	Phone	A value is required.
	Name	A value is required.
	Address	A value is required.
	Relationship	A value is required.
	Phone	A value is required.
I understand that by submitting this application, I authorize a criminal records and a child abuse state central registry checkto be made concerning my suitability as a staff person. In addition, the information in this application and otherwise obtained will be used only for the purpose of determining my eligibility as a staff person. All information will be held in confidence. Criteria used in the selection of staff will be such as to insure that the individual is able to meet the responsibilities of the MVRCR Volunteer Program. No individual will be rejected on the basis of race, color, religious creed, national origin, sex, age or marital status.