Volunteer Application - Ymca Of Greater Long Beach
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5YMCA of Greater Long Beach
PROGRAM VOLUNTEER APPLICATION
PERSONAL
(please give your FULL, LEGAL name)
Last Name
First Name
Middle Initial
Home Phone: (
)
___day ____evening
I prefer to be called:
Alternate Phone: (
)
___work___cell___other
Street Address:
Email Address:
City, State, Zip:
Best time to reach you:
Volunteer position you’re applying for:
I prefer ___home phone ___alt. phone ___e-mail contact.
Are you 21 years or older?: Yes ______ No ______ If No, birth date: __________
Are you a YMCA Member?: Yes_____ Branch:
No_____
Emergency Contact Name:
Relationship:
Phone number:
(Please list someone OUTSIDE your home – in the event of an emergency, we would automatically contact your home first, then this backup contact.)
Have you been convicted of any criminal offense (other than a juvenile offense now expunged from your record) or released from prison in the past ten years?
Yes_____
No_____
If Yes, describe in full:
STUDENT VOLUNTEERS
Are you looking to fulfill a school requirement or will you receive school credit for your service?
Yes_____ No_____
IF YES, name of school:
Is this a Service-Learning requirement or opportunity? Yes_____ No_____
Number of Hours needed:
Deadline to Complete Hours:
COMMUNITY SERVICE VOLUNTEERS
Are you looking to complete Court Ordered Community Service Hours? Yes_____ No_____
IF YES, offense:
Number of hours needed:
Deadline to complete hours:
Parole/Probation Officer’s name:
Phone:
RELATED BACKGROUND
Have you previously volunteered for or been employed by another YMCA? Yes_____
No_____
If Yes, please list all YMCAs and dates:
YMCA:
City, State:
Dates worked
AND/OR
Dates volunteered
1)
1)
1)
1)
2)
2)
2)
2)
Current/most recent employer:
Location:
Position:
How long:
Current/most recently attended school:
Location:
Current year in school/highest level completed:
Date completed (or graduation date):
Other relevant background, training or volunteer experiences:
Certifications held (include date of expiration):
No
Do you have a child/ren participating at the YMCA? If yes, please state first and last name of child/ren.
Have you ever coached at the YMCA before?
Which sports are you interested in coaching? Which season?
REFERENCES
For the safety of our participants, staff and volunteers, we complete at least 2 reference checks on every program volunteer. Appropriate
references may include supervisors, co-workers, faith leaders, teachers or school counselors. Please do not list relatives/household members
or friends.
1
Name:
Phone number:
Relationship to you:
Email:
2
Name:
Phone number:
Relationship to you:
Email:
3
Name:
Phone Number:
Relationship to you:
Email:
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