Carobell, Inc

Station Club Enterprise

Empowering Individuals to

Reach Their Fullest Potential

198 Cinnamon Drive 306 Church St

Hubert, NC 28539 Morehead City, NC 28557

Phone: 910-326-7600 Phone: 252-240-1025

Fax: 919-590-1581 Fax: 919-590-1581

ONE-ON-ONE ADVOCATE APPLICATION - 18 and above

Carobell, Inc. and SCE are committed to allow all qualified individuals an equal opportunity to pursue the volunteer position. There shall be no discrimination against any person or group based on race, color, creed, religion, sex, age, disability or veteran status. Carobell, Inc. and SCE will supply reasonable accommodation that does not cause hardship to volunteer applicants with a known disability.

Date of application: ______

PERSONAL INFORMATION

(Please print legibly)

Name: ______Nickname: ______

(Last) (First) (Middle/Maiden)

Date of Birth: ______

Telephone: ______

(Home) (Work) (Cell)

Email address: ______

Address: ______

(Street Address) (City) (State) (Zip)

Have you ever filed a Volunteer Application with Carobell, Inc. or SCE? Yes/ No: If yes, when? ______Have you ever been arrested? Yes_____ No_____

How did you learn about Carobell’s/SCE Volunteer Program? __Friend __ Newspaper __Volunteer Fair __ other

SKILLS/INTERESTS

What experience if any do you have working with individuals with developmental disabilities or multiple handicaps?

______

______

List any hobbies, special talents, or skills: ______

______

List any previous volunteer experience; ______

______

Why would you like to volunteer at Carobell, Inc.? ______

______

EDUCATION

Please list highest grade completed: ______College: _____ Years: ______Degree: _____

DAYS AND HOURS OF AVAILABILITY

Monday: ____ Tuesday: ____ Wednesday:____ Thursday:____ Friday: ____

Saturday: ____ Sunday:_____

SCE Volunteer hours are from 9am-2pm Monday-Friday

REQUIREMENTS

Have you had a background check in the last 12 months? Yes____ No____

Carobell will conduct a background check for a fee of $13.00 which will be reimbursed after 13 hours of volunteer work.

REFERENCES

Please list at least three (3) references. They should be employers (work or volunteer), instructors, or someone who can give a good account of your work performance. Please do not list friends and relatives. .

PLEASE PROVIDE NAME, FULL MAILING ADDRESS AND VALID PHONE NUMBER.

1. Name: ______Phone number: ______

Address: ______

2. Name: ______Phone number: ______

Address: ______

3. Name: ______Phone number: ______

Address: ______

AUTHORIZATION AND RELEASE OF INFORMATION

I hereby authorize Carobell, Inc. to make inquiries concerning my past employment/volunteer history, and references. I understand a Criminal Background check will also be part of the application process.

______

(Signature) (Date)

Revised: August 2017