Volunteer as an Individual or Group/Organization* (required) IndividualGroup/Organization Group/Organization Name (optional) First Name* (required) Last Name* (required) DOB* (required) Age* (required) Street Address *(required) City *(required) State *(required) Zip Email Address*(required) Cell Phone Number*(required) Alternative Phone Number Client Information Do you live with your parents I live with my MotherI live with my FatherI live with Both my Mother and FatherI live with step MotherI live with step FatherI live alone Are you married YesNo Date of marriage *(required) How many children do you have? *(required) Are a you veteran? YesNo If so, which branch? Are you homeless? YesNo In need of resources YesNo Transportation (Check all that apply) BusPersonal CarRidesBikeWalk Do you have an original non-laminated Social Security card?? YesNo Authorized to work in the US? YesNo Do you have visible tattoos or piercings?(unable to cover) YesNo Where? Do you have a job/interview clothing? YesNo Educational History High School Diploma: YesNo GED YesNo If no, do you want a GED Referral? YesNo Name of School Attending (If applicable) College Degree NoneAS/AABS/BAMA/MS Please describe any Vocational Training you have had (type of program/Certificates/Date Completed)* Typing Certificate YesNo Date Type WPM Do you have a learning disability? YesNo Do you have computer knowledge? YesNo List any languages you Speak, Read or Write (Other than English) Employment History Have You Been Employed? YesNo Are You Currently Employed? YesNo Employer Hours per Week Work Days MonTueWenThurFriSatSun Do You have an updated resume? YesNo Travel History Do You have a passport? YesNo If yes, enter your passport number Do You have a VISA? YesNo If yes, enter your VISA number Which Country is the VISA for? USAOther If other, please list them? How many countries have you visited? Which means of transport have you used before (Check all that apply) PlaneBusTrain Immunization Which Immunization have you had? Yellow Feverother If other, which ones? Volunteer History Have you volunteered before? YesNo If yes, where and which company/church? If yes, for how long? What were your roles as a volunteer in the company/organization Δ
