Volunteer Application

*First Name: Please enter First Name

*Last Name: Please enter Last Name

Other Names Used:

*Date of Birth: Please enter Date of Birth

*Address: Please enter Address

*City: Please enter City

*State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zip: The Zip field is required. ex. 99999

*Email: Email field is required.

*Phone Number:

*Preferred Contact Method - Select all that apply:

WCET HISTORY

*Are you currently or have you ever been a client of WCET?

If yes, when? (approximate dates)

*Has your spouse/partner ever been a client of WCET?

If yes, when? (approximate dates)

EMERGENCY CONTACT

*Emergency Contact First and Last Name: Please enter Emergency Contact First and Last Name

*Emergency Contact Phone Number:

*Your relationship to emergency contact: Please enter relationship

REFERENCES

(do not include immediate family)

(1) Name:

(1) Phone:

(1) Email:

(2) Name:

(2) Phone:

(2) Email:

COMMUNITY SERVICE

*Will your volunteer work be a part of court-ordered community service?

If yes, how many hours are you required to serve?

What date must the hours be completed? (MM/DD/YYYY)

History with Legal System

*Have you ever been arrested or convicted of a criminal offense?
(exclude minor traffic violations for which the fine was $200 or less and any offense that was finally settled in a Juvenile Court or under a Welfare Youth Offender Law)

If yes, please explain (dates, county, disposition) Please enter (dates, county, disposition)

VOLUNTEER OPPORTUNITIES

*What volunteer opportunities are you interested in? (check all that apply)

VOLUNTEER AVAILABILITY

(check all that apply)

*Days

*Time

*Are you willing to volunteer with short notice when needed?

Comments related to your availability:

WE WANT TO HEAR ABOUT YOU!

Why are you interested in volunteering with WCET

What skills, qualifications, certifications, and knowledge do you have that may help you while volunteering with WCET?

Describe a time when you dealt with a difficult situation:

Do you prefer to work independently or collaboratively?

Describe your past volunteer experience, if any:

What else do you want WCET to know about you?

What questions do you have for us?