Volunteer Application First Name Last Name Gender Gender Male Female Age Range Age Range 18-25 26-40 41-60 60+ Phone Number Email Address Address: Street Line 1 Address: Street Line 2 City State / Province Postal/Zip Code Country Prefered Volunteer Duration Prefered Volunteer Duration Short-Term: 1-3 Months Mid-Term: 6-18 Months Long-Term: 1-3 Years Interested in Full-Time Other Prefered start date to Volunteer End Date(Projected) Do you have a passport? Do you have a passport? Yes No Country of issue Expiration Date What program(s) or project(s) interest you, and how you see your skills and knowledge being a benefit to the work of HIMserve? What do you hope to gain from volunteering with HIMerve? Please describe any relevent skills, experiance, or coursework that would make you a strong candidate for a volunteer? Education Information(Last School) Education Information(Last School) Click here to add educational information School Name Grade Level/Degree Years attended Special Honors/ Achievements Employement History(Last Company) Employement History(Last Company) Click here to add employement history Company Name Position/ Title Duration(number of months) What is your role and responsibilities in that company? References: Please provide the names and contact informaiton of two references who can speak to your character, whork ethics, or academic abilities References: Please provide the names and contact informaiton of two references who can speak to your character, whork ethics, or academic abilities Click here to add references First Name Last Name Relationship Phone Number Email Address First Name Last Name Relationship Phone Email Address Have you been convicted of a criminal offence? Have you been convicted of a criminal offence? Yes No Have you volunteered fro other programs before? Have you volunteered fro other programs before? Yes No What is the company organization name? What were your duties? Acknowledgement Acknowledgement By submitting this application, I certify that the information provided is accurate and complete. I understand that any false statements or ommissions may disqualify me from consideration or, if discovered after acceptance, may result in the termination of my involvement as a volunteer. Submit