CEDARS : Join Our Team : Volunteer : Volunteer Online Application

ALL FIELDS ARE REQUIRED TO BE CONSIDERED FOR A VOLUNTEER POSITION! For your application to be considered, you must have all fields filled in.

GENERAL

I am applying to be a:

Today's Date:

Last Name:

First Name:

M.I.:

Social Security #:

Current Address:

City:

State:

Zipcode:

Permanent Address:

City:

State:

Zipcode:

Home Phone Number:

Work Phone Number:

Cell Phone Number:

Drivers License Number (include state):

Date of Birth:

Email Address:

Are there any health issues or physical limitations that could affect volunteer work or require placement modifications?:

If yes, please describe:

SCHEDULE OF AVAILABILITY (select days and times available)

Days:

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

Times:

	Morning (8:00 am to Noon)
	Afternoon (Noon to 5:00 pm)
	Evening (5:00 pm to 8:00 pm)

Frequency of volunteer availability (e.g., weekly, semiweekly, monthly, semimonthly):

Comments regarding schedule of availability:

EDUCATION

Name of High School Attended:

High School, highest grade completed:

High School, year graduated:

Name of College/University Attended:

College/University, years completed:

Major Subjects:

Minor:

College/University, year graduated:

Name of Graduate School:

Graduate School, years competed:

Related Education/Achievements (licenses, trainings, certifications, honors):

PROFESSIONAL EXPERIENCE (list present and past employment beginning with the most recent)

Employer:

Street Address:

Position Held:

Supervisor:

Phone:

Hours Per Week:

From (Mo/Yr):

To (Mo/Yr):

Reason for Leaving:

Specific Duties:

Employer:

Street Address:

Position Held:

Supervisor:

Phone:

Hours Per Week:

From (Mo/Yr):

To (Mo/Yr):

Reason for Leaving:

Specific Duties:

VOLUNTEER EXPERIENCE (List present and past volunteer and military experience beginning with the most recent)

Employer:

Street Address:

Position Held:

Supervisor:

Phone:

Hours Per Week:

From (Mo/Yr):

To (Mo/Yr):

Reason for Leaving:

Specific Duties:

Employer:

Street Address:

Position Held:

Supervisor:

Hours Per Week:

From (Mo/Yr):

To (Mo/Yr):

Reason for Leaving:

Specific Duties:

SPECIAL SKILLS OR QUALIFICATIONS

Summarize special skills or qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or interests:

REFERENCES (other than relatives)

Name:

Address:

Phone:

Relationship:

Name:

Address:

Phone:

Relationship:

Name:

Address:

Phone:

Relationship:

Have you ever been convicted of a violation of law other than a minor traffic violation?:

If Yes, please explain:

Note: a conviction record is not an automatic bar to placement. Each case is considered in relation to the position applied for.

DEMOGRAPHIC INFORMATION

We request your cooperation in completing the following voluntary applicant demographic information. This information will not be used in making any decision affecting employment or any personnel action following employment. It will be used to complete records required of CEDARS by governmental authorities.

Gender:

	Male
	Female

Ethnic Background:

	WHITE (not of Hispanic origin): Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
	BLACK (not of Hispanic origin): All persons having origins in any of the black racial groups of Africa.
	HISPANIC: All persons of Mexican, Puerto Rican, Cuban, Central of South American, or other Spanish culture or origin, regardless of race.
	AMERICAN INDIAN OR ALASKAN NATIVE: All persons having origins in any of the people of North America, and who maintain cultural identification through tribal affiliation or community recognition.
	ASIAN OR PACIFIC ISLANDERS: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent or Pacific Islands. For example, China, Japan, Korea, the Philippines Islands, and Samoa.

Do you have any physical or mental disability?:

	Yes
	No

If yes, please explain:

Citizenship or Immigration Status:

	U.S. Citizen
	Immigrant alien (admitted to the U.S. for lawful permanent residence) with Alien Registration Receipt form I-551
	Non-immigrant alien (admitted to the U.S. temporarily for specific purpose).

RECRUITMENT SOURCE

How did you hear about Volunteer positions with CEDARS?:

	Friend/Neighbor/Relative
	Newspaper Ad
	College/University
	CEDARS Board/Staff Member
	Career/Volunteer Fair
	CEDARS Website
	Other

If other please specify:

I certify that the information contained in this application is true to the best of my knowledge and belief. I grant permission to CEDARS to investigate my employment record, educational record, criminal record, and other records to verify the information I have provided on this application and release CEDARS from any liability resulting from such investigation.

TYPE YOUR NAME TO CERTIFY:

Colored fields indicate required information.

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