Volunteer Application Form

Filling out this application form will help us match you to a volunteer position within JFCS. It also provides the agency with important demographic information that will help us plan for the future.

Date:

I. Background Information

First name: Last name:
Street: City: Zip:
Home Phone: Work Phone:
Cell Phone: Fax:
Email:
Date of Birth:

Gender: Male Female
Relationship Status: Single Married or partnered Widowed
Number of Children:
Number of Children: Under 18 Over 18
Education (indicate highest level achieved):
Field of Study
High School College (2 years) College (4 years) Masters Degree Doctorate Professional Degree
Work Status:
Full-time Part-time Student Retired Full-time parent/homemaker Not Employed
Occupation:
Employer/School:
Have you ever been convicted of a felony? Yes No
(If yes, please describe):
Please describe your previous volunteer experience:
Languages:
English Russian Spanish Hebrew Yiddish French German American Sign Language Other
Other skills, interests, hobbies:
Affiliations (synagogue, church, or organization):
Have you previously applied to JFCS to be a volunteer? : Yes No
How long a commitment can you make? :
6 months 1 year 1 year-plus Short-term projects
One-time special projects
Are you willing to transport clients? (i.e. shopping, doctor appointments, outings): Yes No

Time availability – please check the times you are available

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Mornings
Afternoons
Evenings

Why do you want to volunteer at JFCS?
In which program(s) would you like to volunteer at JFCS?:
Children/Youth Seniors Émigrés Family support
LGBT community People with AIDS, chronic illnesses, or disabilities
Palliative and End of Life Care Transportation Office work
Pet companions
How did you hear about volunteering at JFCS?:
J Weekly Synagogue bulletin JFCS Mailing Word of Mouth
Newspaper
(please indicate which publication)
JFCS Web site Internet
Other (please indicate)
Is there any medical or disability related issue that would affect your ability to perform the job?: Yes No
Have you been exposed to any communicable diseases in the past 6 months?: Yes No

II. Work Experience (please list most recent experience first)

	Dates	Job Title/Description	Employer Name and Address	Reason for Leaving
(1)
(2)
(3)

III. References

Name: Relationship:
Address:
Name: Relationship:
Address:

IV. Emergency Contact

Name: Relationship:
Address:
Home Phone: Work Phone:

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