American Red Cross Mount Rainier Chapter Volunteer Application

Personal Profile  
First Name*

 
Last Name*  
Middle Initial*  
Preferred Name  
Birth Date*  Ex. 12/25/1821
Social Security Number*  
Gender  (Optional)
Ethnicity  (Optional)
Contact Information  
Home Phone* Ex. (253) 474-0400
Daytime Phone* Ex. (253) 474-0400
Cell Phone / Pager  
E-Mail Address  
Home Address* Ex. 911 Tornado Alley Apt. 4C
City*  
State*  
Zip Code*  
Mailing Address Ex. PO BOX 111028
City  
State  
Zip Code  
Employer/School  
Occupation/Student  
Work Phone  

Emergency Contact

  
Name*  
Daytime Phone*  
Evening Phone*  
Relationship*  
Skills, Training and Licenses  
Language Skills and Fluency Ex. English/Fluent; Spanish/Conversational
Professional Licenses or Certifications Include License Number, Issuing State and Expiration Date
Drivers License Number, State, Exp. Date Ex. bartoch508rc MA 12/25/1911
Education and Training   
Current and Previous Work Experience  
Current and Previous Volunteer Service  
Current and Previous Red Cross Experience  
Availability and Interests  
Days of the Week*
Sunday  Monday
Tuesday Wednesday
Thursday Friday
Saturday
Check All That Apply
Time of Day*
Morning
Afternoon
Evening
Short-term Projects
Check All That Apply
Area of Interest*
Armed Forces Emergency Services
Community Disaster Education
Data Entry
Disaster Services
First Aid & CPR Instructor
Friendly Visitors
Office Support
Red Cross Guild
Retired & Senior Volunteer Program
Senior Nutrition Program
Special Events
Youth Services
Check All That Apply
Specific Position (If Known) See Current Volunteer Opportunities
Are there any health conditions which should be considered in your volunteer placement? If so, please describe: Ex. Back Injury not able to lift more than 25 lbs.
How Did You Learn About This Volunteer Opportunity?* Ex. Newspaper
Why Are You Interested in Volunteering?* Ex. Recently Retired
Volunteer Agreement

All information on this volunteer application has been provided voluntarily. I understand that any misrepresentation or omission of facts, regardless of date of discovery may be considered cause for termination or withdrawal of an offer for volunteer service. I have been given a copy of the American Red Cross Code of Conduct explanation, and the Code of Conduct Certification, and if selected as a volunteer agree to comply with these requirements. I agree that my duties are as a volunteer for which I will receive no financial or material compensation.

I give the American Red Cross permission to inquire into my educational background, references, driving record, police records, employment, and/or volunteer history. I further give permission to the holder of such records to release the same to the American Red Cross. I understand that my date of birth and social security number will be used solely to conduct a Washington State Patrol Background Check.

I hold the American Red Cross harmless from any liability, whether civil or criminal, that may arise as a result of the release of this information about me. I further hold harmless any individual, agency, business, or corporation that provides information or documents to the above-named American Red Cross unit. I understand that the American Red Cross will use this information as part of its verification of my volunteer application and periodically for evaluation purposes.

Have you ever been convicted of a felony? Yes No

Have you been convicted of a misdemeanor that resulted in imprisonment? Yes No

If Yes, please explain the circumstances. (This will not necessarily keep you from becoming a volunteer)

Please Initial this box to indicate you have read and understand the above statement