KWA - VOLUNTEER APPLICATION FORM Full Name Application Date Volunteer Position Sought Home Phone / Mobile Phone Email Home Address EDUCATION Highest Level of Education EMPLOYMENT Current Employer, if applicable: Position/Title Dates of Employment (starting, ending) Company/Employer Company/Employer Address Would you like us to keep your employer abreast of your volunteer service and achievement?---YesNo SKILLS & EXPERIENCE Special training, skills, hobbies Groups, clubs, organizational memberships Please describe your prior volunteer experience (include organization names and dates of service) What experiences have you had that may prepare you to work as a volunteer in the field ? Why do you want to volunteer? (Or, What do you want to gain from this volunteer experience?) Have you ever been convicted of a crime? Conviction of a crime is not an automatic disqualification for volunteer work. Do you have a driver’s license?---YesNo Do you have car insurance? ---YesNo Do you have a car available for transporting others? ---YesNo REFERENCES Please list three people who know you well and can attest to your character, skills, and dependability. Include your current or last employer. Name/Organization Name/Organization Name/Organization Relationship to you Relationship to you Relationship to you Length of relationship Length of relationship Length of relationship Phone number Phone number Phone number Please read the following carefully before signing this application: I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Karen Welfare Association of WA Inc that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Karen Welfare Association of WA Inc. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Karen Welfare Association of WA Inc or my termination as a volunteer.