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Volunteer Application
Date: ___________________ Name:_______________________________________ Address: ________________________________________________________________________ SSN:___________________________________ DOB:___________________________________ Drivers License Number:___________________________________________________________ Telephone (h):________________________(w):____________________(c):__________________ Email address:____________________________________________________________________ Best time and way to reach you: _____________________________________________________ I am available to volunteer: Mornings_______________________________ Afternoons______________________________ Evenings________________________________ Weekends_______________________________ I am willing to be called for spot jobs: YES:______ NO: ______ I am available to start: _______________________________________ How did you hear about our Volunteer Service Program? In the event of an emergency, please contact: Name:__________________________________Phone:_____________________________________
Available Volunteer Opportunities Check all interests:
______Driver for clients and tenants ______Reader for tenants ______Instructor, arts and crafts ______Office support (filings and mailings) ______Assist in bowling outings, bingo, spectator sports, cultural events, seasonal recreational activities (skiing, sailing etc), shopping trips, movies, dining out, holistic health programs, etc for tenants of Iris Park Apartments ______Maine
AIRS ______Maine AIRS Brewer broadcast reader (audition required with Director of Maine AIRS)
Volunteer Experience
Volunteer Organization and Address: _________________________________________________ ______________________________________________________________________________ Position:_______________________________________________________________________ Dates of Volunteering:_____________________________________________________________ Volunteer Organization and Address: ____________________________________________ ______________________________________________________________________________ Position:______________________________________________________________________ Dates of Volunteering:___________________________________________________________
Educational Experience
Please indicate highest level of completed schooling: _____High school ______Undergraduate college/university ______Postgraduate Please list any specialized licenses or certifications:____________________________________ ______________________________________________________________________________ Please list any special skills, interests, or qualifications that are relevant for volunteering at the IrisNetwork:__________________________________________________________________________________________ _______________________________________________________ Please send this form to Janet Taylor, Recreation
Therapist/Volunteer Coordinator, The Iris Network, All Iris Network employees and volunteers who work regularly with minors or a vulnerable population are subject to a criminal background check. The applicant may be accepted provisionally while awaiting the background and reference check. The information gathered in this Volunteer application is
designed to help us provide the highest quality of programming for the Iris
Network and the people in the state of Accommodations to enable all individuals to participate in the application process will be provided upon advance request. Program/Facility: ___________________City:__________________________ Name:___________________________________________________________ DOB:____________________________________________________________ Maiden name:_____________________________________________________ Check here_______if you had a criminal history records check with the Iris Network in the past five years. Enter date of last criminal background check:________________________. Please list all your addresses in the past five years: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Have you ever lived in a state other than If Yes, please list State/Dates (example, Ohio/1998-2000) ____________________________________________________________________________________________________ ________________________________________________________ References and Telephone Numbers: (2 work and 1 personal) 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ Your willingness to share your time and talents with the Iris Network is so appreciated! Providing safe and secure programs for our clients and tenants is of utmost importance. _______I understand that a background check will be conducted in conjunction with my service and that I am subject to investigation at any time during my service. In the course of my service, these checks will include but not limited to a comprehensive criminal history records check, a Department of Human Services check, a sex offender registry check, and a driving record check in conjunction with my volunteer service. ______I understand that I can withdraw from the application process at any time. ______I also agree that my volunteer service with the Iris Network is on an “at will” basis, meaning that such may be permanently discontinued by either the Iris Network through termination of my service, or myself through voluntary resigning, at any time without notice and without recourse of any kind by either party. I affirm that the information in this application is true and complete and any intentional deception herein may be considered sufficient cause for termination. My signature below indicates that I have read and understood all of the above. Do not sign until you have read, understood and initialed your agreement to each of the above statements. Applicant signature:___________________________________________________________ Date:____________________________________________
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