Please be as thorough as possible!
* indicates required field Last Name * First Name * Date of Birth Address City: Zip: Day Phone: * Evening Phone: Email Address: * Current Employer: Please Check One: Full Time Part Time Current Position: Educational Background:: Hobbies, Interests: Skills, Abilities: Previous Volunteer experience, if any:: Please check which of the following categories apply to you, if any: Intern United Way/RSVP Work Study Community Restitution What days and times are you available? Please check the appropriate box(es): Monday Morning Monday Afternoon Monday Evening Tuesday Morning Tuesday Afternoon Tuesday Evening Wednesday Morning Wednesday Afternoon Wednesday Evening Thursday Morning Thursday Afternoon Thursday Evening Friday Morning Friday Afternoon Friday Evening Saturday Morning Saturday Afternoon Saturday Evening Sunday Morning Sunday Afternoon Sunday Evening Additional Comments or Notes: Please check what kinds of services you would like to offer: : Transportation: (rides for grocery shopping/to & from work/doctor appointments) Assisting clients: Budgeting/money management/bill paying Household organization/cleaning Childcare: Babysitting Planning activities for children Workshop facilitation: Teaching: One-to-one tutoring Computer training Other Office Assistance: Reception Mailings General Handiwork: Painting Repairs Cleaning Moving Public Speaking: Events organizing: Special Events One Time Only Events Fundraising: Phonathon (December) COTS Walk (May) Other Please check the groups that you are most skilled or interested in working with: Adults Children Families Agency Staff No preference Are there any groups with whom you would not feel comfortable working? Please specify: Please write a short statement describing your reasons for offering time and services to COTS: Please tell us how you heard about COTS: (check the appropriate box) TV/Radio PSA United Way COTS Volunteer Friend Other Please give two professional or, if none, personal references (other than family members and close friends) who can speak to your character and abilities: Personal Reference #1 Name: Personal Reference #1 Phone: Personal Reference #1 Relationship to you: Personal Reference #2 Name: Personal Reference #2 Phone: Personal Reference #2 Relationship to you: Emergency Contact: Name: Phone: Have you ever been in prison, on probation or parole, or fined for any violation of any law or ordinance, other than parking violations? No Yes (If Yes Please explain) Have you ever been the subject of an investigation by Social and Rehabilitative Services (SRS) for suspected child abuse and/or neglect? No Yes (If Yes Please explain)
