Volunteer Service Application - The Children's Inn at NIH

Volunteer Information

Name:*

First Name: Last Name:

Email:*

Address:*

Address Line 1: Address Line 2: City: State: ZIP/Postal Code:

Phone:*

Phone Type*

Education

Highest Level of Education:*

Are you currently enrolled? If so, please list the institution:

Professional Information

Employment Status:*

Current Employer Name:

Position Held:

Dates of Employment (MM/YYYY to MM/YYYY):

Supervisor's Name:

Supervisor's Phone:

Next Most Recent Employer Name:

Position Held:

Dates of Employment (MM/YYYY to MM/YYYY):

Supervisor's Name:

Supervisor's Phone:

Why would you like to volunteer at The Children's Inn?*

List any current or previous volunteer experience(s) you have had. Indicate nature of service and dates:*

List community affiliations (groups, clubs, service organizations, etc.):*

In addition to English, list languages that you can speak/translate fluently:*

What days and times are you available to volunteer?*

Special Skills and Talents (Check all that apply):*

Administrative/Clerical Skills
Graphic Design
Photography
Fundraising
Web Design
Writing/Editing
Facilities Maintenance
Public Speaking
Other

Other Special Skills and Talents:

Indicate Possible Areas of Interest (Check all that apply):

Welcome Desk
Education Tutoring
Organizing Supplies
Summer Camp Program
Interpreters
Fundraising and PR
Acknowledgment Team
Clerical
Other

Other Possible Areas of Interest:

References

Reference #1

First Name: Last Name:

Email:

Phone:

Reference #2

First Name: Last Name:

Non-Family Reference #2 Email:

Phone:

Optional Race/Ethnicity Information:

Certification:*

I certify that the information I have provided is true and correct to the best of my knowledge. I give my consent to my current and previous employers and persons given as references to respond to verbal and written requests for further information. Additionally, I understand that by checking the Accept box on this form, I am giving permission for a security check, including a social security and criminal background check to be run. I hereby pledge to treat any information pertaining to the families, staff, or volunteers of The Children's Inn as personal and confidential. I understand that any breach of this confidentiality can result in immediate termination of my volunteer placement. The Children's Inn volunteers have an ethical responsibility to protect the privacy of the residents and staff. Further, I voluntarily offer my services with a clear understanding that there will be no monetary compensation. I will be prompt and regular in my service. I will notify the appropriate person if I am unable to perform my volunteer duties as assigned. I agree to conform to all policies and regulations as applicable to The Children's Inn. I understand that volunteers must be 18 years of age.

I Accept the Above Certification

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