Corporate Headquarters

Corporate Headquarters

1161 Ingleside Road

Norfolk, VA23502

Attention: Volunteer Services Manager

Phone: (757) 858-8011 Fax: (757) 627-4760 Email:

Eggleston Services is an EOE/Affirmative Action Employer

Volunteer Services Application

TO THE APPLICANT: EGGLESTON SERVICES IS AN EQUAL OPPORTUNITY EMPLOYER. EGGLESTON SERVICES MAKES EMPLOYMENT/VOLUNTEER DECISSIONS BASED ON QUALIFICATIONS ONLY WITHOUT REGARD TO RACE, RELIGION, COLOR, NATIONAL ORGIN, ANCESTRY, SEX, AGE, MARITAL STATUS, DISABILITY, MEDICAL CONDITION, SEXUAL ORIENTATION, VETERAN STATUS, OR OTHER NON-JOB RELATED FACTORS PROHIBITED BY APPLICABLE FEDERAL STATE OR LOCAL LAWS. EGGLESTON SERVICES PROVIDES APPLICANTS WHO HAVE DISABILITIES WITH REASONABLE ACCOMODATION TO ASSIST IN THE INTERVIEW/ HIRING PROCESS. APPLICANTS REQUIRING ACCOMODATION SHOULD CONTACT THE HUMAN RESOURCES OFFICE. EGGLESTON SERVICES IS A DRUG-FREE WORKPLACE. THIS DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY BEFORE AN OFFER OF VOLUNTEER SERVICE CAN BE AUTHORIZED

PERSONAL INFORMATION

Last Name:______First Name:______Date:______

Address:______City______State______Zip ______Home Telephone: ______

Alternate Telephone______Email Address: ______

In Case of Emergency, Notify:

Name:______Relationship:______Telephone:______

WORK/VOLUNTEER EXPERIENCE

Previous Volunteer Experience: Yes NoWhere?______When?______Current Employer: ______

Telephone: ______

Business Address: ______City: ______State:______Zip______

Level of Education Completed: ______Field of study______

Hobbies/Skills/Special Interest: ______

Why did you decide to volunteer at Eggleston Services? ______

TIME AVAILABILITY
Days / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
Morning9-12
Afternoon12-4
Evening4-9

(over)

Are there any work activities or conditions you must avoid? ______

Have you ever been convicted of a crime? No Yes If yes, please explain: ______

______

REFERENCES

List two (2) personal/professional references that have known you for more than one year:

Name / Address / Phone / Relationship
1.
2.

May we contact your references? Yes NoInitial______

What program/site/event are you offering your volunteering services? ______

I will/will not permit a police background search if required. (Circle one)

______

Volunteer Applicant Signature Date

I certify that all answers in the Volunteer application are true and correct, and have been given voluntarily; I understand that I am volunteering my services without contemplation of compensation or employment. I agree to keep confidential from outside sources all information obtained throughout my volunteer experience at Eggleston Services. I understand that this is privileged information and not to be shared with anyone, other than a current member of Eggleston Services and then, only as necessary to carry out my task or assignment.

______

Volunteer Applicant Signature Date

FOR OFFICE USE ONLY Date ____/____/____
Court Ordered Volunteer Services (check): Court Documentation reviewed:
Number of hours needed: ______Required by: ____/____/____
Background Search Conducted: Yes No Convictions: Yes No
Date Application Received: _____/_____/______Date of Interview: _____/_____/______
Date of Orientation: _____/______/______Site Supervisor: ______
Site Assigned: BSD DS TC CA RS DOE: ___/___/___ TB Required? Yes No Date: ______