Personal Information

First Name

Middle Name

Last Name

Date of Birth

Previous Names (if Applicable):

Address (Street)

Address (City)

Address (State)

Address (Zip)

Home Phone

Work Phone

Drivers License Number

Social Security Number :

E-Mail Address

RESIDENCE HISTORY: (List residences for the last three years. List your current address first)

Residence-1 : (Street, City, State, Zip Code, & How Long)

Residence-2 : (Street, City, State, Zip Code, & How Long)

Residence-3 : (Street, City, State, Zip Code, & How Long)

Employment History (List for the last three years, beginning with the most recent position)

Employment-1 : (Company Name, Complete Address, Telephone Number & How Long)

Employment-2 : (Company Name, Complete Address, Telephone Number & How Long)

Employment-3 : (Company Name, Complete Address, Telephone Number & How Long)

LANGUAGE SKILLS

Are you bilingual?

Yes

If Yes, second language

Speak

Read

Proficiency:

Fair

Good

Excellent

EDUCATION AND TRAINING (List highest level of education and any specialized training received)

INTERESTS, SKILLS AND AVAILABILITY

Hobbies-And-Interests

Special Skills:

What skills do you have which would be helpful as a volunteer?

In what areas are you interested in volunteering your services?

Previous Volunteer Experience:

Approximate number of hours per week you can volunteer :

DAYS AND HOURS AVAILABLE

Morning days/hours:

Afternoon days/hours:

Evening days/hours:

REFERENCES

List Three References: (Name, Address, City, State, Zip Code, Phone Number) - Reference (1):

Reference (2):

Reference (3):

BACKGROUND INFORMATION

List all arrests, charges, dates of arrest, and disposition (excluding traffic tickets):

Are you currently on probation or parole ? chose an option

Probation

Parole

Not Applicable

How did you hear about the volunteer program ?

Citizen Academy

Referral

Other

If other, explain :

ADDITONAL ANIMAL SHELTER QUESTIONS

Have you ever worked with animals before ? if yes, in what capacity ?

Do you have allergies to animals ?

Have you ever adopted an animal from an animal shelter ?

ADDITIONAL ANIMAL SHELTER QUESTIONS CONTINUED

We make every effort to see that animals in our care are adopted. However, there are instances when an animal becomes unadoptable and is euthanized. How do you feel about this ?

Volunteering for the animal shelter is not only animal related; It also involves constant contact with the public. How do you feel about interacting with all types of people ?

VOLUNTEER ACTIVITIES

Please Check all that apply :

Administrative - answering phones, stuffing envelopes, assisting the public and officers with office work.

Dog WalkerDog Walker - direct contact with dogs: socialization, training, and exercise.

NAN Program - temporary care and feeding for orphaned kittens at the volunteer's home.

Laundry / Maintenance - wash, dry, and fold blankets and towels.

Assist staff with cleaning of the shelter and helping with feedings.

Community events - assist staff with outreach, adoption events, and educational handouts.

Signature :*

Date*