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Volunteer Application Personal Profile Application Date:____________________________ First Name:____________________________ Last Name:____________________________ Title:
Home Address:________________________________________________________________________________________ City:_____________________________________________________ State:__________ Zip Code:____________________ Home Phone:_______________________ Work Phone:_______________________ Cell Phone:_______________________ Email:________________________________________________ Would
you like our Email newsletter? Please provide the names and contact information for two personal references we may contact: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
Tell us a little more about you! 1) Do you have a community service
requirement that you need to fulfill?: If yes, number of hours:____________________ To be completed by (date):____________________ Hours are required for: 2) How did
you hear about Island Harvest?:
3) Please describe your previous and current volunteer activities, including organization names and your responsibilities: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 4) Please list any skills that may relate to your commitment to us or that you wish to use as a volunteer: _____________________________________________________________________________________________________ 5) Day(s) Available: Hours
Available: 6) Favorite Radio Station?:_______________ Restaurant?:____________________ Newspapers?:____________________ 7) Are you affiliated with a business, school, group or organization that might be interested in becoming involved with Island Harvest?:
Affiliation Name:________________________________________________________________________________________ Affiliation Address:______________________________________________________________________________________ City:_____________________________________________________ State:__________ Zip Code:____________________ Affiliation Phone:__________________________________ Affiliation E-Mail:_______________________________________ 8) What else would you like us to know about you?___________________________________________________________ _____________________________________________________________________________________________________
Please check all the volunteer opportunities that interest you!
*When picking
up food in either your own vehicle or an Island Harvest vehicle
you MUST have a valid NYS Driver’s License.
Emergency Contact Information Name:________________________________________ Relationship:____________________ Phone:____________________ Parental Consent/Signature (required if volunteer is a minor – under 18):_____________________________________________
PLEASE READ AND SIGN THE FOLLOWING. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED. THANK YOU! I confirm that all information on this application is true, and agree to observe all Island Harvest rules and regulations. I understand that I may be required to attend an orientation and training session and that my completed application does not guarantee me a volunteer assignment. Signed:_____________________________________________________________ Date:______________________________ Print Name:_____________________________________________________________________________________________
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Mr. 