Volunteer Application Form

Name (First, MI, Last):
Organization:
Address:
City:
State:
Zip Code:
Home phone:	Area code ( ) -
Work phone:	Area code ( ) -
Fax:	Area code ( ) -
E-mail:
Marital Status:	__ Married __ Divorced __ Single __ Widowed
Number of children:
Date of birth:
Race:
Religion:
Occupation:
Education:
Foreign languages:
Sign language:	__ Yes __ No

Hobbies, clubs, special interests, skills:

Do you have a car?	__ Yes __ No
Is it important to you that your Compeer friend be of a specific age, religion, ethnic background, or sexual orientation?	__ Yes __ No

If yes, please describe:

Do you have any medical or psychological conditions that affect your health?	__ Yes __ No

If yes, please describe:
How did you learn about Compeer?
Why are you interested in becoming a volunteer?
Please provide us with your employment history, including names of supervisors. Depending on your length of employment, one or more supervisors will be contacted for a character reference check. We also require a personal reference who can comment on your ability to serve as a volunteer. The reference cannot be a relative and must have known you for at least one year. (For full-time students, please provide two references from your college experience.)
EMPLOYMENT HISTORY (most recent job first; include relevant volunteer work)
Job title:
Dates:	From __________ To __________
Employer name:
Employer address:
Employer city, state, zip code:
Supervisor name:
Phone:	Area code ( ) -
Job title:
Dates:	From __________ To __________
Employer name:
Employer address:
Employer city, state, zip code:
Supervisor name:
Phone:	Area code ( ) -
Job title:
Dates:	From __________ To __________
Employer name:
Employer address:
Employer city, state, zip code:
Supervisor name:
Phone:	Area code ( ) -
PERSONAL REFERENCE
Name:
Address:
City:
State:
Zip Code:
Phone:	Area code ( ) -
Relationship to you:

Check the programs in which you are interested:	__ 1:1 Match __ Clerical work/mailings __ Fundraising __ Other (please describe): __________________________
Availability (number of hours per week you can help):

If organization, indicate resources you can provide (e.g., space for meetings):
Compeer is aware of the sensitive nature of some of the questions asked. It has been our experience that having as much information as possible about each individual (whether volunteer or client) increases our ability to match people successfully. All information is requested to ensure, to the greatest degree possible, the success of the matching process. Compeer does not discriminate on the basis of age, gender, ethnicity, religious affiliation, or sexual orientation. I understand that the information given by me is confidential, and that, as a volunteer, I will help the client to the best of my ability in accordance with the policies of the agency. I will maintain complete confidentiality concerning all information about Compeer clients. I further understand that the interview by a Compeer staff person does not obligate me to accept, nor Compeer to assign, a volunteer opportunity.
Applicant's signature:
Date: