Date: |
2/6/2012 |
Your
Name: |
First
Last
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Date of Birth: |
(19xx) |
Street Address: |
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City/State/Zip: |
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Phone(s) where we can reach you: |
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Fax: |
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Email Address: |
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Where did you hear aboout I Care?: |
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Name and phone numbers of two (2) references
(not related):: |
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Current or previous
work experience: |
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Current or previous volunteer experience: |
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Emergency Contact
& Phone: |
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Driver's License Number: |
Expiration:
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Make and Model of Vehicle: |
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Vehicle Insurance Company Name: |
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Accidents or tickets
in past 5 years: |
If yes, please describe below
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In connection with your volunteer application and registration, I CARE will need to check your driving record and/or general background. Please sign to indicate your permission to do so.
Electronic Signature Yes
No
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The following information will help us match your preferences with client needs: |
How many rides do you wish to take per month? |
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Times or days you are NEVER available? |
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When are you available to start? |
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If in general, there are particular days and times you are most available, you may indicate them by putting a check ion the chart below. NOTE: If your schedule varies, and you prefer to notify us of your availability periodically, you need not complete this chart. |
Days |
Morning
(9:00am-12:30) |
Afternoon
(12:30-4:30pm) |
Notes |
| Monday |
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| Tuesday |
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| Wednesday |
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| Thursday |
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| Friday |
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Do you speak any languages other than English? If so, which ones?
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Please indicate any additional skills you may be able to offer on an occasional basis:
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Speaking to civic, religious, or other groups about I CARE
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Word processing/data entry
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| Answering office phones
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Fundraising
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| Media Relations
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Grant writing
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| Graphic design/desktop publishing
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Special event planning
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| Music or other entertainment at I CARE events
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Web design
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| Computer/IT support
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Other (please list):
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Thank you! Upon completing this application, please select the "Send Volunteer Application" button below.
Then
call I CARE at 404-377-2273 to schedule a sign-up appointment. |
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