EmailMe Form - LIGHT OF CHANCE, INC. VOLUNTEER APPLICATION

Contact Information:

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number

### - ### - ####

Email *

Social Security Number:

Emergency Contacts:

Please list TWO

Name:

First Last

Relationship:

Phone

### - ### - ####

Name:

First Last

Relationship:

Phone

### - ### - ####

Special Medical Information:

Please list any conditions or medications such as allergies, asthma, etc.

Employment Information:

Are you presently employed:

Yes

No

If Yes, Name of Employer:

Job Title & Length of Employment:

Phone

### - ### - ####

Education

Last Grade Completed:

12th Grade

Some College

Completed College

Graduate School

Any relevant training experiences:

Personal skills, interest, hobbies:

Volunteer interest:

Type of work you would like: (check all that apply)

Working with students in after-school programs.

Helping in the office.

Special Events or Activities.

Other

Time you prefer to work:

Flexible

School Hours

After School

Lunch Hour

Days available:

Is there a time you are not available?

Have you ever been convicted of a crime? If yes, please explain:

As a volunteer, I agree to:

• Submit to a criminal records check if asked.
• Attend orientation/training session that may be necessary to help in my job or to prepare me for my role with the constituents Light of Chance serves.
• Honor my commitment to work as scheduled.
• Notify my supervisor as soon as possible if I must be absent from a scheduled commitment.
• Submit the name, phone number and email address of my professor for open lines of communication with Light of Chance (if volunteering for class credit).

I understand that Light of Chance has the right to terminate this agreement at any time.

Please enter your name as acknowledgment of e-signature:

First Last

Date Time

MM / DD / YYYY