Volunteer Application for JWCH Institute, Inc.

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Volunteer Application

Application to Join the JWCH Volunteer Program

We appreciate your interest in becoming a JWCH volunteer. At JWCH, you will find a wide range of opportunities in which to participate. We also offer Community Service Credit for any Court Ordered Volunteer Services.

Because of the diversity of our volunteer opportunities, concern for the health and well being of our clients, volunteers and staff, and depending upon which area you decide to assist in, there may be several forms for you to complete. Thank you for your patience and understanding. If you have any questions and/or need assistance, please contact me at (213) 484-1186 or via e-mail at cespinoza@jwchinstitute.org.

Please be advised that some programs require a Health Assessment examination, which includes (but is not limited to) a T.B. (Tuberculosis) test. The Health Assessment can be done on site at JWCH by trained professionals at no cost to the volunteer.

I look forward to meeting you. Thank you for your interest in helping JWCH to fulfill our mission.

Application Form

Personal Information
First and Last name:	*
Home Address, Line 1:	*
Home Address, Line 2:
City:	*
State:	*
Zip Code:	*
Daytime Telephone:	*
Evening Telephone:	*
Your Email Address:	*

Occupation/Profession:

Your Driver's License or State I.D. Card Number:
State of Issue:
Name by which you would like to be called (nickname):

If you are under 18 years of age, can you provide required proof of your eligibility to work?:	Yes No
How did you hear about JWCH?:
What propmted you to volunteer?:
What date/dates/days are you able to volunteer?:
What time/times are you able to volunteer?:
Can you travel if your volunteer duties require it?:	Yes No
Have you been convicted of a felony within the last 7 years?: (Information will be kept confidential. Conviction will not necessarily disqualify an applicant)	Yes No
If yes to above, please explain:

Education
High School Attended:
Dates Atttended:
Major Course of Study:
Granduated/Certificate Revd?:	Yes No
College/University Attended:
Dates Attended:
Major Course of Study:
Granduated/Certificate Revd?:	Yes No
Post Graduate/Professional School:
Dates Attended:
Major Course of Study:
Graduated/Certificate Recv?:	Yes No

Please list any specific skills, talents and computer knowledge that might be useful in your volunteer work:
Is there a specific volunteer job/position you are interested in?
Do you speak or write any languages other than English? (explain):
Please list any additional information you feel may be helpful to us in considering your application:

Personal References (please list three)
Reference Name 1:
Reference 1 Phone:
Describe how long you've known this person and your relationship with them:
Reference Name 2:
Reference 2 Phone:
Describe how long you've known this person and your relationship with them:
Reference Name 3:
Reference 3 Phone:
Describe how long you've known this person and your relationship with them:

Employment References
Company Name 1:
Supervisor's Name 1:
Supervisor's Phone 1:
Describe your relationship with this employer, including duties performed and dates of employment:
Company Name 2:
Supervisor's Name 2:
Supervisor's Phone 2:
Describe your relationship with this employer, including duties performed and dates of employment:

Volunteer References
Organization Name 1:
Supervisor's Name 1:
Supervisor's Phone 1:
Describe your volunteer assignments and length of time you served with this agency:
Organization Name 2:
Supervisor's Name 2:
Supervisor's Phone 2:
Describe your volunteer assignments and length of time you served with this agency:

Comments/anything you wish to add to this application:
*Required Information By submitting this on-line volunteer application to JWCH Institute, Inc., I certify that all answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all statements contained in this volunteer application as may be necessary in arriving at a decision. In the event of volunteer employment, I understand that false or misleading information given in my application or interview may result in discharge. Additionally, I understand that I am required to abide by all rules and regulations of JWCH Institute, Inc. (A signed copy of this application will be required upon approval.)

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