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.