NESF Volunteer Application NESF Volunteer Application Personal InformationName(Required) First Name Last Name Date Of Application MM slash DD slash YYYY Address City State / Province / Region ZIP / Postal Code Home PhoneMobile Number(Required)Email Adress(Required) How did you learn of these volunteering opportunities at NESF? Are you under 18 years of age? Yes No When will you be able to begin volunteering? MM slash DD slash YYYY Medical HistoryOptions Arthritis Diabetes Asthma Heart problems Low/High Blood Pressure Other Are you able to stand for long periods of time? Yes No Are you able to lift a minimum of 50lbs? No Yes Please List them. Are you currently taking any medication? Yes No Please List them. Do you have any allergies? Yes No Do you have any allergies? Emergency Contact Information (Please list two)Name(Required) First Name Last Name Relation Home PhoneMobile PhoneName First Name Last Name Relation Home PhoneMobile PhoneEducationName of High School First Address City State / Province / Region Years CompletedDiploma/ GEDName of Graduate School First Address City State / Province / Region Years CompletedDiploma/ GEDName of College/University First Address City State / Province / Region Years CompletedDiploma/ GEDOther (Business/Trade/Technical) First Address City State / Province / Region Years CompletedDiploma/ GEDAvailability (Please indicate the days and hours that you are available.)Monday MorningTime Hours : Minutes AM PM AfternoonTime Hours : Minutes AM PM EveningTime Hours : Minutes AM PM Tues MorningTime Hours : Minutes AM PM EveningTime Hours : Minutes AM PM AfterNoonTime Hours : Minutes AM PM SkillsWhich of the following activities interest you? (check all that apply)(Required) Sorting Food Using multiple lines telephone system Pickups and Deliveries (Lifting Boxes) Data Input Translating (which Language?) ___________________ NOTIFICATION AND ACKNOWLEDGMENT – Please read before signing.I certify that all answers provided are true, accurate and complete. I understand that any falsification, misrepresentation or omission of fact on this application (or any other accompanying or required document) will be cause for denial or dismissal from volunteering opportunities regardless of when or how it is discovered. I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me. Applicant’s Signature(Required) First Date(Required) MM slash DD slash YYYY
