Volunteer ApplicationIf you prefer to complete this application on paper, click here to download a PDF version. Name * First Name Last Name Email * Home Phone (###) ### #### Work Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Ethnicity (Optional) Occupation/Place of Employment Previous Work Experience Special Skills/Hobbies Community Affiliation (Church, Service Club, Organization) Previous Volunteer Experience Are you bilingual? If yes, what languages? Physical Limitations/Health Concerns (including allergies) Have you ever been convicted of a felony? Yes No If yes, please explain. Volunteer Opportunities That Interested Me Office Volunteer Speakers Bureau Advocacy/Public Policy Fundraiser Assistance Board of Directors Other If other, please explain. Location Preferred (Check all areas you are willing to serve) Alpine County Amador County Calaveras County Colusa County El Dorado County Nevada County Placer County Sacramento County San Joaquin County Sierra County Sutter County Yolo County Yuba County Please list time available. Specify days, evenings, and weekends. Emergency Contact Emergency Contact Name First Name Last Name Emergency Contact Relationship Emergency Contact Day Phone (###) ### #### Emergency Contact Evening Phone (###) ### #### Physician Name First Name Last Name Physician Phone (###) ### #### References Please list TWO names of persons not related to you whom you have known at least one year. Reference 1 Name First Name Last Name Reference 1 Phone (###) ### #### Reference 1 Address Reference 2 Name First Name Last Name Reference 2 Phone (###) ### #### Reference 2 Address Do we have your permission to use your name or picture in news articles and media releases? Yes No Please tell us why you want to be a volunteer. Thank you!
