NEW VOLUNTEER APPLICATION FORM

NAME_______________________________________________            DATE__________________

 ADDRESS: (STREET, CITY, STATE, ZIP CODE)  

LOCAL                                                                                                         OUT OF TOWN

 
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BIRTHDATE: _____________

PHONE #S            LOCAL__________________________________

                                OUT OF TOWN___________________________

                               CELL____________________________________

                               WORK___________________________________

 
FULL TIME RESIDENT________   PART TIME RESIDENT_______(EXPLAIN)

 
ARE YOU RETIRED_____, SEMI-RETIRED____, WORKING FULLTIME____

 HAVE YOU DONE ANY OTHER VOLUNTEER WORK? 

                NO______            YES_____ (EXPLAIN)

 
IS THERE ANY INFORMATION YOU WOULD LIKE TO SHARE (LIFE EXPERIENCES, EDUCATION, SKILLS, TALENTS, COMPUTER SKILLS, HOBBIES) THAT WOULD BENEFIT A VOLUNTEER POSITION AT PRIME HOOK?

WHAT TIMES OR DAYS ARE YOU INTERESTED IN VOLUNTEERING?

                I AM FLEXIBLE________, WEEKDAYS_________, WEEKENDS______

 
 DO YOU HAVE A VALID DRIVER’S LICENSE?

                NO_______         YES______ (STATE)_____________________

 
WOULD YOU PREFER TO WORK ON YOUR OWN_________, WITH A PARTNER_________, OR IN A GROUP______?

DO YOU HAVE ANY PHYSICAL LIMITATIONS, OR UNDER A DOCTOR’S CARE, THAT MAY LIMIT YOUR ABILITY TO PERFORM CERTAIN JOBS? If YES, PLEASE EXPLAIN.

ALLERGIES ETC. (EX. POISON IVY)

VOLUNTEER JOB(S) YOU WOULD BE INTERESTED IN DOING.

                 ____TRAIL MAINTENANCE

                ____VISITORS’ CENTER

                ____EDUCATION

                ____CONSTRUCTION (HUNTING STANDS ETC.)

                ____OFFSITE EXHIBITS

                ____PARADE FLOATS

                ____HORSESHOE CRAB SURVEY

                ____OUTDOOR MAINTENANCE (EX. WEEDING ETC.)

                ____VOLUNTEER PATROL (PATROLING REFUGE GROUNDS)

 
NOTICE TO VOLUNTEER

 VOLUNTEERS ARE NOT CONSIDERED TO BE FEDERAL EMPLOYEES FOR ANY PURPOSES OTHER THAN TORT CLAIMS AND INJURY COMPENSATION. VOLUNTEER SERVICE IS NOT CREDIBLE FOR LEAVE ACCRUAL OR ANY OTHER BENEFITS. HOWEVER, VOLUNTEER SERVICE IS CREDITABLE WORK EXPERIENCE.

 PRIVACY ACT STATEMENT

THE FOLLOWING INFORMATION IS PROVIDED TO COMPLY WITH THE PRIVACY ACT (PL 93-579).5 U.S.C. 301 AND 7 CFR260 AUTHORIZE ACCEPTANCE OF THE INFORMATION REQUESTED ON THIS FORM. THE DATA WILL BE USED TO CONTACT APPLICANTS AND TO INTERVIEW, SCREEN, AND SELECT THEM FOR VOLUNTEER ASSIGNMENTS. FURNISHING THIS DATA IS VOLUNTARY.

SIGNATURE (IN INK)____________________________________________DATE____________