| Name |
|
| Address |
|
| City |
|
| State |
|
| Zip |
|
| Home
Phone |
|
| Work Phone |
|
| E-mail |
|
| Fax |
|
| Birthdate |
|
| Employer |
|
| Address |
|
| Brief
Employment History |
|
| |
| May We Contact
You at Work? |
 Yes
No
If
so, what is the best time?
|
| |
| Have You Ever
Been Arrested? |
Yes
No
If
yes, were you convicted?
Yes
No |
| |
| How did you
hear about a Phalanx? |
|
|
| |
| Why would you
like to become involved with Phalanx? |
|
|
| |
| Other
Volunteer Work |
|
|
| |
| Other
Community Involvement and Offices Held: |
|
|
| |
| Please list
any Special Skills or Hobbies: |
|
|
| |
| Time You Can
Volunteer: |
Weekly
Monthly
Best
Day(s)
|
| |
| Type of
Volunteer Work You Are Interested In |
|
|
| |
| Would You Be
Interested In Heading a Committee? |
|
Yes
No |
| |
| Would You Be
Interested In Being on the Board of Directors? |
|
Yes
No
Perhaps |
| |
| Do You Have
Any Ideas for Fund Raisers or Ways to Keep the Volunteers
Involved? |
|
|
| |
Please list
the names, addresses and day phone numbers of two people who
have known you for at least two years.
The references I listed may be contacted by
telephone or email.
|
Name:
Address:
Address 2:
Phone:
|
Name:
Address:
Address 2:
Phone:
|
I understand that PFS has my permission to use my
name and photographs of me to promote the
organization.
I certify that
the information contained in this volunteer application is
correct to the best of my knowledge. Further, I consent to
my current and previous employers, and other people given as
references, responding to the verbal or written request for
further information. I understand that in my association
with Phalanx Family Services, I may from time-to-time learn
of or be exposed to certain sensitive or confidential
information, including but not limited to: identities of
prospective participants, their background information, as
well as identities of sponsors or donors, and other
budgetary and administrative information about and/or its
programs. To avoid embarrassment to and foster the orderly
administration of and its programs, I agree not to disclose
any information learned by me in my association with to the
media or anyone else, except for my general impressions of
concept and program, and I agree to refer any inquiries
about its programs, participants, sponsors, or donors to the
Executive Director or its Board of Directors for an
appropriate response.
I hereby certify that
clicking the below Submit button signifies my signature to
the above statement.
|
