Volunteer Form

Volunteer Application

All of the information requested on this form will be kept confidential. We only ask questions that are relevant to making a good match. You may choose not to answer any/all questions marked “optional.” Thank you for your understanding and cooperation.

Personal Information

First Name: *

Last Name: *

Middle Initial:

Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Email:*

Home Phone:

Cell Phone:

Work Phone:

Call at Work?:

Birthday:

day

month

year

Race:

Religion:

Marital Status:

Education/Training/Certifications (including any degrees held, CPR, etc.)

Hobbies, Special Interests, Skills

Foreign Languages you can speak:

Can you speak sign language?:

Do you smoke?

Are you willing to be matched with a smoker? :

Is it important that your match be of a particular race and/or religion?:

What age range do you prefer?:

Do you have any medical or psychological problems that significantly affect your health?

Employment History

Company:

Occupation:

Company Address, City, State, Zip:

Supervisor’s Name:

Supervisor’s Daytime Phone:

Employment Dates:

Personal Reference
(The reference cannot be a relative and must have known you for at least one year)

Reference Name:

First

Last

Reference Phone:

How long have you know this person?

What is their relationship with you?

Background Information

Birthplace City:

Birthplace State/Country:

Driver’s License # :

State:

Do you have a car?

Auto Insurance Company:

Has your license ever been suspended?

Have you ever been convicted of a crime (except minor traffic violations)?

Are there any misdemeanor and/or felony charges pending against you now?

Why do you want to volunteer for Compeer?

What three words best describe you?

Because of the client population we serve is vulnerable; we must screen our volunteers carefully. Your cooperation in completing thisform is greatly appreciated. A “yes” to any question does not necessarily disqualify you from becoming a volunteer. Additionally, as arequirement of volunteering, all applicants will be subject to the required criminal background check. The necessary form has beenprovided to you.

I certify that the above information is accurate and give Compeer my permission to verify this information with theappropriate agency/person. I understand that as a volunteer, I will help my friend to the best of my abilities inaccordance with the policies of Compeer & will maintain complete confidentiality concerning all information about myfriend. I understand that submission of an application and an interview does not obligate me to accept, or Compeer toassign a volunteer opportunity.

Signature:*

Date of Signature:

About Compeer

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