VOLUNTEER APPLICATION
(Please Type or Print All Information)
PERSONAL INFORMATION:
Name:
First Middle Last
Home Address:
Street Apt. No.
City State Zip Code
E-mail:
Home Phone: Office Phone:
Cell Phone: (For Emergency Use Only, unless otherwise instructed)
Date of Birth: (mm/dd/yy) Gender: (M/F) Ethnicity:
Are you a citizen of the United States? (Mark One) YES NO
INTEREST IN OAR:
Do you feel you would be able to work objectively with any type of offender? ( )Yes ( )No
If no, please explain:
Have you ever volunteered and/or been employed in the Criminal Justice System?
( )Yes ( )No If yes, where, and what did you do?
Do you know anyone who is currently incarcerated in a local Adult Detention Center?
( )Yes ( )No If yes, please explain:
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EDUCATION COMPLETED:(with level attained)
GED/High School:
College: Degree: Field of Study:
Other Education and/or Training:
Professional Certification:
EMPLOYMENT INFORMATION:
Present Employment: Dates of Employment:
Position Title: Name of Supervisor:
Business Address:
Telephone:
VOLUNTEER EXPERIENCE:
Organization: Dates with Organization:
Volunteer Work Performed:
Organization: Dates with Organization:
Volunteer Work Performed:
HEALTH INFORMATION:
Do you have any health conditions or allergies which could impair your proficiency in your work? (Mark One)
( )Yes ( )No If yes, please explain:
ACTIVITY INFORMATION:
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Do you speak any languages other than English?(Check One) ( )Yes ( )No
Language:
Speak fluently Read fluently Write fluently
REFERENCES (Please provide three references and do not include relatives)
Name: Phone No.
Street Address:
Town/City: Zip:
Email:
Relationship:
Name: Phone No.
Street Address:
Town/City: Zip:
Email:
Relationship:
Name: Phone No.
Street Address:
Town/City: Zip:
Email:
Relationship:
EMERGENCY INFORMATION: Person to contact in case of emergency:
Name: Relationship:
Address:
City: State: Zip:
Home Phone: Work Phone:
Cell Phone: Email:
VOLUNTEER POSITION(S): List 1-3 Volunteer Positions that interest you.
Instructions for Adding Text to a PDF Document
· Download and save the file to your desktop
· Open the PDF document
· Click on the tab “Fill & Sign” on the tool bar at the top of the document
· A menu will appear on the right side of the document under the tab “Fill & Sign”
· Click on “Add Text”
· A cursor will appear (….) like an upside down “T”
· With your mouse, move the cursor over the line in the data field, line up the dotted line on the bottom of the cursor with the solid line in the data field and type the information on that line
· Repeat for each data field
· Save the document
· Attach the completed application to an email and send it to
ü Fax document to OAR Fairfax - Darien Ruggles fax number: (703)273-7554
ü Mail hard copies to:
OAR NOVA
Attn: Jessica Reh
10640 Page Ave
Suite 250
Fairfax, VA 22030
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