American Red Cross - Muskingum Lakes Chapter

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Volunteer Application

Fields denoted with * are required fields:

First, we need a little information about you.

Last Name*

First Name*

MI

Birthdate (mm/dd/yyyy)*

Home Address*

City*

State*

Zip*

Home Phone*

Cell Phone

Your Email Address

Now, some information about your job history. (In chronological order)

Organization Name

Address, City, State

Start Date thru End Date

Supervisor

Organization Name

Address, City, State

Start Date thru End Date

Supervisor

Volunteer History

Have you volunteered with Red Cross Before?

Education, Training & Special Skills

Have you volunteered with any other organizations?

Your Volunteer Interests

CPR/First Aid Water Safety Babysitting Youth Safety

Disaster Services Casework Youth Club Meal Preparation

Office Work Admin/Accounting Fund Raising/Dev Word Processing/PC Skills Public Relations Special Projects/Events Leadership

Giving Your Time

Monday : Monday Morning Monday Afternoon Monday Evenings

Tuesday: Tuesday Morning Tuesday Afternoon Tuesday Evenings

Wednesday: Wednesday Morning Wednesday Afternoon Wednesday Evenings

Thursday: Thursday Morning Thursday Afternoon Thursday Evenings

Friday: Friday Morning Friday Afternoon Friday Evenings

Weekend: Weekend Morning Weekend Afternoon Weekens Evenings

More Background Data

Answering YES will not necessarily disqualify any applicant.

Has your drivers license ever been revoked? Yes No

Driver's License Number

If bonded, has your bond ever been revoked? Yes No

Have you ever been convicted of a felony or within the last 24 months, a misdemeanor that involved imprisonment? Yes No

Have you ever held a Red Cross Certification? Yes No

Have you ever had a Red Cross Certification revoked? Yes No

If you answered yes to any of the above, please explain

Why do you want to volunteer for the American Red Cross?

© 2010 American Red Cross – Muskingum Lakes Chapter
1451 4th Street Northwest, New Philadelphia, OH - (330) 343-8633
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