Volunteer Application

	Volunteer Application
	Volunteer Application

About You

Last Name:

First:

MI:

Home Address:

City:

State:

Zip Code:

Home Phone:

Email:

Job History (most recent first)

Organization #1 Name:

Address:

Dates:

Phone:

Supervisor:

Organization #2 Name:

Address:

Dates:

Phone:

Supervisor:

Volunteer History

Red Cross:

What:

When:

Where:

Other organizations:

What:

When:

Where:

Education / Training / Skills

Highest education level attained:

Degree:

Where:

When:

Professional license(s):

What:

State:

Exp. Date:

Foreign language:

Language:

Written: Yes No Speaking: Yes No

Other skills:

What:

Your Volunteer Interests (check activities which interest you)

Teaching Others	Helping Others	Helping Us
CPR/First Aid Water Safety Disaster Education	Disaster Services Driver Casework Youth Programs	Office Work Admin./Accounting Fund Raising/Development Word Proc./PC Skills Public Relations/Marketing Special Projects/Events Board Leadership

Giving Your Time

Please check your volunteering availability:

Monday:	Morning	Afternoon	Evening
Tuesday:	Morning	Afternoon	Evening
Wednesday:	Morning	Afternoon	Evening
Thursday:	Morning	Afternoon	Evening
Friday:	Morning	Afternoon	Evening
Weekend:	Morning	Afternoon	Evening

Some Background Data (A Yes will not necessarily disqualify any applicant)

Has your driver's license ever been revoked?	Yes	No
If ever bonded, was your bond ever revoked?	Yes	No
Have you ever been convicted of a felony, or within the last 24 months, of a misdemeanor that involved imprisonment?	Yes	No
Have you ever held a Red Cross certification?	Yes	No
Was your Red Cross certification ever revoked?	Yes	No
If you answered YES to any of the above, please explain:
Why do you want to volunteer with the American Red Cross? (Optional):

Volunteer Consent for Reference and Background Checks

I do hereby give the American Red Cross permission to inquire into my educational background, references, driving record, police records, employment, and/or volunteer history. I further give permission to the holder of any such records to release the same to the American Red Cross.

I do hereby hold the American Red Cross harmless from any liability, whether civil or criminal, that may arise as a result of the release of this information about me. I further hold harmless any individual, agency, business, or corporation that provides information or documents to the above named American Red Cross unit. I understand that the American Red Cross will use this information as part of its verification of my volunteer application and periodically for evaluation purposes.

Name: Date:

In lieu of a signature, please enter your mother's maiden name:

Emerge

ncy Contact Name: Phone: Relationship:

Contact us via email: info@mlcredcross.org