Community Support Services : Get Involved : Volunteer Application

Community Support Services
9021 Ogden Avenue
Brookfield, IL 60513
708.354.4547
fax: 708.387.0756
www.communitysupportservices.org

PERSONAL INFORMATION

First Name:

Middle Initial:

Last Name:

Birth Month/Day:

Current Street Address:

City:

Zip Code:

Home Phone:

Alternate Phone:

Email Address:

How often do you check your email:

EMPLOYMENT INFORMATION

Employer:

Position:

Work Phone:

May we contact you at work:

	Yes
	No

EMERGENCY INFORMATION

Emergency Contact:

Phone Number:

Relationship:

VOLUNTEER INFORMATION

How did you hear about our volunteer program:

Do you require any special accommodations to volunteer:

Previous Volunteer Experience:

Do you speak/write any language in addition to English? If so, please list:

Special Skills:

(mark all that apply)

If Other Skills, please indicate:

Special Events:

Office/Facility:

	Work Day at CILA homes
	Gardening
	Computer Work
	Filing
	Mailings
	Flyer Distribution
	Special Projects

AVAILABILITY

Indicate daytime or event hours available.

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

Have you ever been convicted of a felony:

	Yes
	No

If Yes, please explain:

Verification:

I understand that I am applying to be an unpaid volunteer for Community Support Services and that this is not an application for employment. I hereby release Community Support Services, its officers, directors, employees, volunteers and participants from any liability for any loss cost or damage to me or my property arising out of or in connection with my volunteer assignment. I certify that all answers given by me are true, complete and correct. I authorize Community Support Services to complete a background and reference check if pertinent to the volunteer program area. If I am accepted as a volunteer, I agree to abide by the requirements of the program and the agency policies and procedures for Community Support Services' volunteers.

Applicant Name: