Volunteer Application Form
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1
2Family YMCA of Marion & Polk Counties
Volunteer Application
Volunteers are considered without regard to race, color, national origin, gender, age, sexual orientation, physical or mental disability, or any
other bias protected by federal, state, or local legislation concerning equal opportunity employment.
PERSONAL INFORMATION
NAME__________________________________________________________________________________________________________
LAST
FIRST
MIDDLE
HOME ADDRESS__________________________________________________________________________________________________________________________________________
STREET
CITY
STATE
ZIP
PRIMARY PHONE__________________________________________________________
SECONDARY PHONE_________________________________________________
EMAIL___________________________________________________________________
ARE YOU 18 YEARS OF AGE OR OLDER? ___YES ___NO
EMERGENCY CONTACT NAME & PHONE #______________________________________________________________________________________
AREAS OF INTEREST/SKILLS
Please check all that apply
CHILDREN: ( )CHILD WATCH
( )COACHING
( )DANCE
( )AQUATICS
( )CAMP (
) YOUTH ACTIVITY CENTER
YOUTH: ( )HOUSING FOR YOUTH & GOVERNMENT
ADULTS: ( )LOCKER ROOM ATTENDANT
( )FITNESS CLASSES
( )WEIGHT TRAINING
EVENTS: ( )SET-UP/TAKE-DOWN
( )PROMOTIONAL BOOTH
( )ACTIVITIES BOOTH
FACILITY: ( )REPAIRS/IMPROVEMENTS
( )LAUNDRY
( )CLEANING
( )RESTOCK SUPPLIES
FUNDRAISING: ( )CAMPAIGNER
( )BOOK SALE
ADMINISTRATION: ( )BOARD MEMBER
( )ADVISORY BOARD
OFFICE/CLERICAL: ( )WEB SITE
( )BULK MAIL
( )FILING
( )TRANSLATION-(ENGLISH TO: _______________________)
OTHER: ( ) COMMUNITY SERVICE: EXPLAIN_____________________________________________________
AVAILABILITY & LOCATION
DATE AVAILABLE TO BEGIN__________________________
BRANCH/LOCATION_______________________________________
APPROXIMATE NUMBER OF HOURS AVAILBLE _______________ ( )per DAY
or( )per WEEK
or( )Per MONTH
or ( )Per YEAR
CHECK ANY TIMES YOU ARE AVAILABLE TO VOLUNTEER:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
MORNINGS
AFTERNOONS
EVENINGS
COMMENTS ABOUT AVAILABILITY:____________________________________________________________________________________________
EMPLOYMENT HISTORY
Please provide at least 6 months of employment history. Use additional sheets if necessary.
EMPLOYER #1
_______________________________________________________________________ JOB TITLE_______________________________________________________
DATES OF EMPLOYMENT-FROM__________________ TO __________________
SUPERVISOR NAME_______________________________________________
SUPERVISOR PHONE_______________________________
IS IT OK TO CONTACT THIS EMPLOYER? ___YES
___NO
EMPLOYER #2
_______________________________________________________________________ JOB TITLE_______________________________________________________
DATES OF EMPLOYMENT-FROM_____________________ TO ______________________
SUPERVISOR NAME____________________________________________
SUPERVISOR PHONE_______________________________
IS IT OK TO CONTACT THIS EMPLOYER? ___YES
___NO
VOLUNTEER EXPERIENCE
Use additional sheets if necessary for more volunteer experience.
ORGANIZATION NAME
_________________________________________________________________ VOLUNTEER DATES-
___________________
____________________
FROM
TO
SUPERVISOR NAME_________________________________________________________________________
SUPERVISOR PHONE_____________________________________________
WORK PERFORMED_____________________________________________________________________________________________________________________________________________________
Family YMCA of Marion & Polk Counties, 685 Court St. NE, Salem, Or 97301
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