|
Talbot County Department of Social Services VOLUNTEER APPLICATION Name and Contact Information Name_________________________ ________________________________ _____ Last First MI Address________________________________________________________________ City/State/Zip____________________________________________________________ Mailing Address, if different_______________________________________________ Phone: Home_________________________ SS# ________________________ MD Driver’s License# ______________________ How did you hear about volunteer opportunities at TCDSS? web site____ newspaper____ flier___ presentation____ friend____ Availability: When would you prefer? days ____________________ hours ___________________ seasons ____________
Volunteers are asked to commit to a period of one year of volunteer service to the program. Are you agreeable to this? Y____ N____ If no, explain_______________________________________________________ Education: High School___ GED___ College___ # Years/degree _________ ______ Areas of study which would apply to your TCDSS volunteer work:__________ Employment History Are you currently employed? Y____ N____ Indicate jobs you have held within the past five years. If possible, please include a resume. Most recent employer_____________________________________________________ Address____________________________________________________________________ Dates of Employment _____________________________________________________
Former employer__________________________________________ Address_____________________________________________________________________ Dates of employment ______________________________________________________ List special skills, abilities, interests, i.e., computer skills, languages, etc. ______________________________________________________________ ______________________________________________________________ List other volunteer experiences you have had and describe your duties: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Please check the following area(s) of interest: Elderly ___________ Teenagers ________ Children __________ Disabled __________ Nursing home residents _______ Other _______________________________________ Please check the following activities you would be interested in: ____ home visiting with elderly customers ____ escorting elderly or disabled adults to appointments ____ help complete job applications, obtain job information ____ supervise parent/child visits for foster program Help foster families: ____ transport children to and from visits ____ transport children to and from appointments ____ complete lifebooks for children being adopted ____ assist children with homework Aid Families: ____ teach parents budgeting skills ____ teach parents household management skills ____ model behavioral management techniques for parents ____ assist with coordination of nurturing and support groups for parents/children ____ assist with networking community resources such as goods and services needed by families ____ mentoring for parents ____ mentoring for children Other: ____ maintain inventory of donated goods from the community ____ assist with special projects or events ____ provide agency administrative support ____ file reports, records or assist with mailings ____ update databases, create spreadsheets
Personal History: Please give us some information about your motivations for volunteering with this program. Explain any volunteer or professional experience you have had that relates to your indicated areas of volunteer interest.
________________________________________________________________________
________________________________________________________________________
References List 3 people whom we may contact. These should not be relatives but should be employers, teachers or community members. Name _____________________________ relationship ________________ Address _________________________________________________________________ Phone: daytime__________________________ evening__________________________
Name _________________________________________ relationship _________________ Address _____________________________________________________________________ Phone: daytime__________________________ evening__________________________
Name__________________________________________ relationship _______________ Address _____________________________________________________________________ Phone: daytime__________________________ evening__________________________ I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. If accepted as a volunteer, I understand that any misstatement or omission of fact on this application may result in my dismissal. I hereby give my permission for you to verify any information included in this application. I further understand that all volunteers who will have contact with children and vulnerable adults are required to undergo a state and federal criminal background check at the agency’s expense. By signing below, you agree that you will keep confidential all information you learn about customers or families if you perform volunteer duties for this agency. Failure to do so will result in dismissal. signature _________________ date______________________
4/04/08
|