Volunteer Interest Form - Children & Families First

Children & Families First2005 Baynard Boulevard, Wilmington, DE 19802302-777-9762, 302-658-5170 (fax)Email: Kathie.stamm@cffde.orgVOLUNTEER/INTERN INTEREST FORMName __________________________________________________________ Month/Day of Birth ________________________Address ____________________________________________________________ Home phone __________________________City ______________________________________________ State ____________________ Zip __________________________Employer __________________________________________________ Work Phone ___________________________________Email Address ____________________________________________________ Fax ____________________________________Emergency Contact Information:Name ______________________________________ Relationship____________ Phone _________________________________Education: Please list schools and dates of attendance _____________________________________________________________Hobbies, skills, interests_____________________________________________________________________________________Previous volunteer experience ________________________________________________________________________________Have you ever been convicted of a crime? Yes____ No____ If yes, please explain_____________________________________How did you hear about our volunteer needs? ___________________________________________________________________References: Please list name, address, and telephone number of three (3) persons you have known for at least two years so that wemay contact them. Please do not list relatives. Your first reference should be your current supervisor (if applicable.) Telephone will beour first means of contacting your references unless you request otherwise.1. Name _______________________________________________________ Daytime Phone_____________________________Address ______________________________________________________ Fax _____________________________________City ______________________________State ____ Zip _______________ E-mail ___________________________________Relationship ___________________________________________________Years known ______________________________2. Name _______________________________________________________ Daytime Phone_____________________________Address ______________________________________________________ Fax _____________________________________City ______________________________State ____ Zip _______________ E-mail ___________________________________Relationship ___________________________________________________Years known ______________________________3. Name _______________________________________________________ Daytime Phone_____________________________Address ______________________________________________________ Fax _____________________________________City ______________________________State ____ Zip _______________ E-mail ___________________________________Relationship ___________________________________________________Years known ______________________________

Availability1. At what times are you interested in volunteering?__ Weekdays __ Afternoon __ Evenings__ Weekends* __ Morning __ Other:*Although some programs may occasionally offer weekend opportunities, our regular business hours are 9:00am to 5:00pm weekdays.2. Do you have a geographic preference as to where you would like to do volunteer work?__ No__ Yes: ______________________________________________________________Preferences in Volunteering1. Is there a particular type of volunteer work in which you are interested? (Please check all that apply.)__ Working with small groups__ No preference_ Working on community fairs and events_ Working one-on-one_ Helping around the office in general administrative and clerical duties_ Other:______________________________________________________________________________________________2. Is there a person or group with whom you are particularly interested in working? (Check all that apply.)_ Adults _ Teens __ Children _ Agency staff __ No Preference_ Other:_______________________________________________________________________________________________3. Do you speak or write a language in addition to English?_ No_ Yes:____________________________________________________________4. What sort of time frame would you like to volunteer with Children & Families First?_ One time _ Ongoing _ Monthly _ Quarterly5. Do you have any additional preferences that you can share to help us find the best volunteer opportunity for you?____________________________________________________________________________________________By filing this application, the potential volunteer/intern agrees to participate in Children & Families First’s volunteer/internapplication process. This will include but is not limited to an interview, reference check, a criminal history check, TB testing, and amotor vehicle record check.The information provided by me on this form is true to the best of my knowledge. Any false statement on this profile may result inloss of my intern/volunteer position. I have read and understand the above information and agree to conditions set forth._________________________________________________________Signature______________________________DateTo be filled out by volunteer coordinator/ volunteer supervisor:_ Work Technology Policy _ Code of Ethics _ Criminal Background Check _ Behavioral Management Policy___ Confidentiality Policy _ Driver’s License/ID _ Vehicle Policies ___TB Test/Results __Abuse/Neglect Policy__ Media Communications Policy __Client Rights Policy __ Duty to Warn/Protect __ Sexual Harassment Policy__ Personal Data Form __ Criminal History Affidavit ___ Vehicle Policies ___Record Review Policy __ResumeDate Started:___________________________________ Assigned to:____________________________________ Rev 4/11/2012