Please Include a Current Resume If You Have One

Volunteer Application Form

(Please include a current resume if you have one)

Personal Information:

Full Name: ______

Mailing Address: ______

City: ______State: ______Zip Code: ______

Cell phone Number: ______E-mail Address: ______

Information about your education:

Highest level completed:

High School ____ Some College ____ College ___ Graduate School____

If applicable, please list the college(s) that you are attending now or graduated from: ______

If applicable, please denote what academic year you are currently in:

Freshman______Sophomore______Junior______Senior______

I need volunteer hours for school/college credit: ______If yes, how many? ______

Information about your current or most recent employment (or attach resume):

Employer: ______From (M/Y): ______To:______

Position/Duties: ______

Current employment status:

Full time ___ Part time ___ Unemp1oyed ___ Retired ___

Information about previous employment (or attach resume):

Employer: ______From (M/Y): ______To:______

Position/Duties: ______

Employer: ______From (M/Y): ______To:______

Position/Duties: ______

Information about your skills, experience and interests:

Please list your skills and/or experience that relate to a volunteer position with CHI OC:

______

______

______

Computer programs and degree of expertise in those programs:

______

Please list the languages, besides English, that you know and your level of fluency:

______Verbal: ______Written______

______Verbal: ______Written______

Please list your current and previous volunteer roles with location and duties performed (if any):

______

______

______

Please describe why are you interested in volunteering here at CHI OC?

______

______

______

Information about your schedule andavailability:

What is your availability? Monday:______Tuesday:______Wednesday:______Thursday:______Saturday:______Sunday:______

How many hours a week and what hours do you plan to work? ______

How many months do you plan on volunteering? ______

Is there any health reason that might limit your ability to volunteer? Yes _____ No______

If yes, please describe: ______

Children’s Health Initiative of Orange County reserves the right to conduct state and federalbackground checks.

Have you ever been convicted or plead guilty to a felony or misdemeanor? Yes _____ No_____

If yes, please explain:______

______

Background investigation

This investigation may include, but is not limited to, a criminal backgroundcheck in the files of any Federal, state or local justice agency, driving history,performance of medical examinations, drug screening or reference verification.

Dress Code

Unless otherwise instructed when volunteering in the CHI OC office volunteers must dress according to the business casual dress code.

I understand the requested information is for the sole purpose of gathering accurateinformation for volunteer services at Children’s Health Initiative of Orange County.I have read and understand the above and by my signature consent to these statements.

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Applicant Signature or InitialsDate

Send application to • phone (714) 619-4050

Community Health Initiative of Orange County • 1505 E. 17th Street, Suite 121, Santa Ana, CA 92705