Volunteer Application

Application Date *
Volunteer Position Sought *
Name *
Home Address: *
Work Phone *
Home Phone
Emergency Contact Name and Telephone Number *


Highest Level of Education *


Current Employer, if applicable
Dates of Employment (starting, ending)
Would you like us to keep your employer abreast of your volunteer service and achievement?
Have you ever worked with special needs children?
Name(s) of Organization?
Dates of Volunteering (starting, ending)
Do you consent to a background check?


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 of [description of field, e.g., domestic violence, child abuse prevention, youth recreation, etc.]
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? [If yes, please explain the nature of the crime and the date of the conviction and disposition.] Conviction of a crime is not an automatic disqualification for volunteer work.


Please list three people who know you well and can attest to your character, skills, and dependability. Include your current or last employer.

References *

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 Complete The Puzzle, 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 Complete The Puzzle, Inc. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Complete The Puzzle, Inc. or my termination as a volunteer.

Signature *
Maximum file size: 512 MB
Date *