Volunteer+enrollment+form 2

VOLUNTEER ENROLLMENT FORM Name________________________________________________________ Date __________________________ Address_____________________________________________________________________________________ City_______________________________________ State___________________ Zip______________________ Home Phone_________________________ Work Phone_____________________ Cell Phone_______________ Emergency Contact Name __________________________________________ Phone______________________ SKILLS AND INTEREST

……………………………………………………………………………………………………………….. Education background High School Undergraduate GED Junior College Graduate Other Current occupation____________________________________________________________________________ Hobbies, skills, interests ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Previous volunteer experience ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Preferences in volunteering Working one-on-one with a single client Working one-on-one with a group of clients Working directly with a staff person as a an assistant

Doing research, training, or an individual project Public Speaking, fundraising, etc No preference Other

AVAILABILITY ……………………………………………………………………………………………………………….. At what times are you interest in volunteering? Mondays AM/PM

Tuesdays AM/PM

Wednesdays AM/PM

Thursdays AM/PM

Fridays AM/PM

Saturdays AM/PM

Sundays AM/PM

Do you have reliable transportation? Yes/No BACKGROUND VERIFICATION ……………………………………………………………………………………………………………….. Have you ever been convicted of a criminal offense? Yes/No Have you ever been charged of neglect, abuse, or assault? Yes/No Has your driver license ever been suspended or revoked in any state? Yes/No Do you use illegal drugs? Yes/No D a y S t a r R a n c h ● P. O . B o x 2 2 4 ● R e d B l u f f C A 9 6 0 8 0 ● ( 5 3 0 ) 5 2 9 - 2 6 7 9 .

Do you have any physical limitations or are you under any course of treatment which might limit your ability to perform certain types of work? Yes/No PERMISSION TO PERFORM BACKGROUND CHECK ……………………………………………………………………………………………………………….. I hereby allow Daystar Ranch to perform a check of my background, including Criminal record Driving record Past employee/volunteer history Personal references Physician or Therapist I understand that I do not have to agree to this background check, but that refusal to do so may exclude me from consideration for some types of volunteer work. I understand that information collected during this background check will be appropriately limited to determining my suitability for particular types of volunteer work and that all such information collected during the check will be kept confidential. I herby also extend my permission to those individuals or organizations contracted for the purpose of this background check to give their full and honest evaluations of my suitability of the described volunteer work and such other information as they deem appropriate Sign_______________________________________________ Date____________________________________ Please list two non-family members whom we might contact: Name_____________________________________________ Phone____________________________________ Name_____________________________________________ Phone____________________________________ ……………………………………………………………………………………………………………….. How did you hear about us? Position description Advertisement Volunteer Center/Website Posting Website

Family/Friend/Co-workers Client of Agency Employee of Agency Other

PARENTAL CONSENT ……………………………………………………………………………………………………………….. I understand that my child named above wishes to be considered for volunteer work and I hereby give my permission for them to serve in that capacity, if accepted by the agency. I understand that they will be provided with orientation and training necessary for the safe and responsible performance of their duties and that they will be expected to meet all the requirements of the position, including regular attendance and adherence to agency policies and procedures. I understand that they will not receive monetary compensation for the services contributed. Parent Name______________________________________ Signature___________________________________________ Relationship to Applicant _________________________Phone_______________ Date______________________________

D a y S t a r R a n c h ● P. O . B o x 2 2 4 ● R e d B l u f f C A 9 6 0 8 0 ● ( 5 3 0 ) 5 2 9 - 2 6 7 9 .