Volunteer Application

* indicates a required field

First Name * :     Last Name * :

Address * :     City * :

State*     Zip Code * :     Email * :

Phone * :     Alternate Phone * :

Date of Birth * :     Social Security Number:

Salary Expected $/hour * :    -OR-    $/year * :

Position Applied For * :

Comment

Recruitment*

How did you hear about The Douglas Center? (Please select one)

   Company Website

   Newspaper or Online Ad:    Source:

   Employee Referral:    Employee:

   Other:

Availability*

Full Time Part Time On Call

*Please indicate the times available below (i.e. 9am-4pm):

Interests

Indicate below the area(s) in which you are interested.

Volunteering	Internship Program
Fundraising	Counseling/Therapy
Clerical/Admin. Duties	Intake and Assessment
Sewing	Program Case Management
Music/Dance
Special Events
Arts and Crafts
Gardening/Horticulture
Money Management
Community Integration
Thrift Store/Deli/Cooking

Education (Put N/A if not applicable)

Attended	Name/Address	Years Attended	Diploma/Degree Received
High School*
College/ University
Other

Previous Volunteer or Work Experience

Personal/Professional References*

Please list 2 references that are familiar with your work and/or volunteer experience. (References should not be relatives):

Name	Relationship	Phone Number

Please Read carefully and sign below

I understand that any false, misleading or incomplete statements made as part of this application or omission of information may be considered sufficient reason for immediate dismissal.

I authorize appropriate personnel of the Agency to investigate my references and to make inquiries of courts and law enforcement agencies resulting from such investigations. Information furnished or recovered as a result of any inquiry will not necessarily preclude my acceptance into the program, but will be considered part of an overall evaluation of my qualifications.

I understand that nothing on the application is intended to create or imply a contractual relationship, if accepted. I understand that the volunteer/internship program is at will and can be terminated with or without reason at any time. Only a written agreement signed by the President & Chief Executive Officer can change my status. Upon termination, I authorize the release of reference information on my work and I hold the Agency harmless for the release of the information.

I understand that I will not be compensated for any hours worked for the Volunteer and/or Internship Programs at The Douglas Center.

Applicant Signature (typed):