VOLUNTEER APPLICATION

Please complete application, and initiate background check.

First Name *
Last Name *
Address *
City *
State *
Zip Code *
Phone Number *
Email Address
Best time to contact you?
Date of Birth *
Ethnicity *
Referred By
Employer's Name
Employer's Address
Are you a licensed driver?	Yes No
Are you a student?	No Yes, Part-Time Yes, Full-Time
List previous experiences (volunteer, paid, or educational) that would be helpful in working with people:
List any skills, hobbies or interest you have that may be helpful in your volunteer work:
Do you speak, write or read any other language beside English. Yes No
If yes, please list the language(s).
Please give the name of any person(s) we should notify in an event of an emergency:
Name *
Address
Phone Number *
Relationship *
Name
Address
Phone Number
Relationship
Please list two personal/professional references:
Name *
Address *
Phone Number *
Name *
Address *
Phone Number *
Do you hold any American Red Cross certifications?    Yes No
If yes, please list:
Please select the American Red Cross service(s) where you feel you would like to volunteer:
Health and Safety
Clerical (Lighting and Filing) Helping at Health Faires Assisting with mailings Baby-sitting Instructor	First Aid and CPR Instructor Water Safety Instructor Lifeline Outreach Program
Disaster Services
Disaster Action Team	Fire Safety Education
Blood Services
Community Blood Drives Blood Donor Center	Volunteer Driver
Administration
Assisting with mailings Clerical (data entry, filings and answering the switch board)	Special Events Public Relations
Availability
Daytime Evening Weekdays Weekends	Daily Weekly Monthly
Would you be willing to serve in the event of a disaster?    Yes No
Please give your reason for volunteering with the American Red Cross
I understand that the above infomation may be disclosed for American Red Cross purposes and that as a Red Cross volunteer, I will not be paid for my services.
Signature *
If Minor, Parental Consent Signature