Human Resources · 7 Bishop Street · Framingham, MA · 01702 · FAX 508-879-2248

Volunteer Application

______

Name: Last: ______First:______

Address: ______

Town: ______State: ______Zip Code: ______

Phone # ______Cell # ______

Work # ______Email: ____________

1. Where did you hear about South Middlesex Opportunity Council Volunteering Opportunities?

______

2. Are you currently employed? Yes No

Who is your employer? ______

3. Have you volunteered before? Yes No Where: ______

What talents will you bring to your volunteer experience? Please circle all that apply:

Computer Data Entry Organizational Maintenance Events Kitchen Leadership Carpentry Painting Other:

______

4. Please give details of any relevant work, study; volunteering and personal/family experiences that you feel may be applicable to your role as a volunteer.

______

5. Education: Please list educational background including diplomas/degrees, area of study, special training or relevant skills.

______

______

Are you currently in school? Yes No How many hours per week? ______

6. Please indicate how frequently you would like to volunteer?

Once a week / More than once a week
Once a month / Periodically on request

7. What times/days are you available to volunteer?

MON / TUE / WED / THUR / FRI / SAT / SUN
Morning
Afternoon
Evening
Hours/Availability

8. Are you licensed to drive in Massachusetts? Yes No

9. Do you have a car available to you? Yes No

10. Are there any limitations to your ability to drive a motor vehicle? Yes No

Please explain if yes:

______

______

11. Do you speak or write any other languages, other than English, fluently? Yes No

If yes, which? ______

12. Do you have a resume? Yes (If yes, please attach a copy.) No

13. List three words that describe your overall attitude: ______

______

14. For our Voices Against Violence program ONLY, please indicate which opportunities you’re

looking to explore (check all that apply):

___ Community Outreach and Education

___ Kid Space Supervised Visitation

___ Emergency Shelter*

___ Crisis Intervention Hotline*

___ On-Call Sexual Assault Medical Advocacy*

*Please note that these volunteer opportunities require 45 hours of pre-service training. This training is provided by Voices Against Violence free of charge for qualified applicants.

References: Identify three personal/professional references:

Name: ______Address: ______

Phone: ______Relationship: ______

Name: ______Address: ______

Phone: ______Relationship: ______

Name: ______Address: ______

Phone: ______Relationship: ______

I acknowledge that I am freely volunteering my time without compensation or the expectation of compensation and that either SMOC or I may terminate this agreement at any time without prior notice for any reason. I hereby authorize SMOC to check my references and I understand that a criminal background check is required. I understand that after I submit my application, it will be reviewed and my eligibility for volunteer work will be determined. I hereby release and waive liability against SMOC, a non-profit corporation, its directors, officers, employees and agents, its successors and assignees, for any injuries or illness that I or my dependent may suffer in connection with any volunteer work for SMOC.

We know you have many choices in how and where to volunteer your time and talents and we appreciate your interest in South Middlesex Opportunity Council!

______

Volunteer Applicant Signature Today’s Date

We are an Equal Opportunity Employer. We consider applications for all positions without regard to age, race, ethnicity, nationality, religion, gender, sexual orientation, military status, disability, or any other legally protected status pursuant to Massachusetts Fair Employment Practices Act, and other relevant federal, state and local laws. Those applicants requiring reasonable accommodation to the application and/or interview process should notify Human Resources.

3