NESF Volunteer Application

NESF Volunteer Application

Personal Information

Name(Required)
MM slash DD slash YYYY
Address
Are you under 18 years of age?
MM slash DD slash YYYY

NEWARK EMERGENCY SERVICES FOR FAMILIES VOLUNTEER APPLICATION

Medical History

Have you ever had or do you presently have any of the following? Please answer: YES or NO
Options
Are you able to stand for long periods of time?
Are you able to lift a minimum of 50lbs?
Are you currently taking any medication?
Do you have any allergies?

Emergency Contact Information (Please list two)

Name(Required)
Name

Education

Name of High School
Address
Name of Graduate School
Address
Name of College/University
Address
Other (Business/Trade/Technical)
Address

Availability (Please indicate the days and hours that you are available.)

Monday

Morning
Time
:
Afternoon
Time
:
Evening
Time
:

Tues

Morning
Time
:
Evening
Time
:
AfterNoon
Time
:

Skills

Which of the following activities interest you? (check all that apply)(Required)

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)
MM slash DD slash YYYY