Volunteer Application Form

Application For Volunteer Services

Thank you for your interest in volunteering. We will review your application and may contact you. Please note that we are seeking volunteers who are 18 years or older and are residents of Contra Costa County. Please check back soon if the location you are interested in is not currently taking applications.

Location

Personal Information

*
*
*
*
*
 
 
*
~ Email address must be applicant’s email as the email address submitted will be used to obtain a background screen containing private information.
*

Emergency Contact

*
 
 
*
 

Current Employment (if applicable)

 
 
 
 Yes
 No
 
 
 
 

School (if applicable)

 
 Yes
 No
 
 

Prior Experience

 
 
*
 Yes
 No
*
 Yes
 No
*
 Yes
 No
 

Reasons for Volunteering

*
*
 Yes
 No
*

How you heard about us?

*
 Current/Former Volunteer
 Phone Book
 Former Patient
 Advertisements
 Referral
 Staff Member
 Website
 Other
 

Services that you are interested in

*
 Patient contact services
 Non-Patient contact services
 

Things in which you are experienced and/or interested

*
 Clerical Duties
 Mailing Projects
 Telephoning
 Hosting/Registration
 Photography
 Knitting/Sewing

Other Information

 
~ Limitations will not necessarily disqualify you from volunteering.
 
 
 
 Asian
 Black or African American
 American Indian or Alaska Native
 Native Hawaiian or Other Pacific Islander
 White
 Hispanic or Latino
 Two or More Races
 Other
~ Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sex.

References

This information is required. Please provide two references with complete address. (No relatives; preferably a supervisor/former supervisor if available)
*
*
*
*
*
*
*

     

*
*
*
*
*
*
*

Declaration

The typed name below shall have the same force and effect as your written signature. You declare that the above information is accurate and correct to the best of your knowledge. Also this indicates your approval to contact your references. The Volunteer Services Department is not obligated to provide a placement nor are you obligated to accept any offered volunteer assignment.
*