Volunteer Application Survey

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1. Thanks for your interest in becoming an Opportunity Junction volunteer! Please complete this form.

Thanks for your interest in becoming an Opportunity Junction volunteer! Please complete this form. Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

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2. Emergency Contact Info

Emergency Contact Info Name:
Relationship:
Phone:
Alternate Phone:

3. Are you over the age of 18?

Are you over the age of 18?

4. Are there other emails or phone numbers that will help us to reach you?

Are there other emails or phone numbers that will help us to reach you?

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5. How did you hear about Opportunity Junction?

How did you hear about Opportunity Junction? A friend, family member or relative A staff member A volunteer A volunteer referral agency	Another organization, non-profit or agency Internet search My employer Newspaper, TV or radio (which one?)	Saw a flyer (where?) Someone at church or temple Teacher/school activities leader
Other (please specify)

6. Why would you like to volunteer with Opportunity Junction?

Why would you like to volunteer with Opportunity Junction?

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7. What are you interested in doing? Please check all that apply.

What are you interested in doing? Please check all that apply. Curriculum Development Fundraising Help people learn basic English skills Help people learn Computer Skills Help people learn English as a second/foreign language	Help people learn Math skills Mentor a participant in our Job Training & Placement Program Program Development Teach Workshops Volunteer Recruitment/Coordination
other

8. When would you like to volunteer?

	MM		DD		YYYY
Beginning Date	When would you like to volunteer? Beginning Date Month	/	Day	/	Year
Ending Date	Ending Date Month	/	Day	/	Year

9. What days and times are you available?

	9 am - 12:30 pm	12:30 - 5 pm	5 - 9 pm
Mondays	*What days and times are you available? Mondays 9 am - 12:30 pm	Mondays 12:30 - 5 pm	Mondays 5 - 9 pm
Tuesdays	Tuesdays 9 am - 12:30 pm	Tuesdays 12:30 - 5 pm	Tuesdays 5 - 9 pm
Wednesdays	Wednesdays 9 am - 12:30 pm	Wednesdays 12:30 - 5 pm	Wednesdays 5 - 9 pm
Thursdays	Thursdays 9 am - 12:30 pm	Thursdays 12:30 - 5 pm	Thursdays 5 - 9 pm
Fridays	Fridays 9 am - 12:30 pm	Fridays 12:30 - 5 pm	Fridays 5 - 9 pm
Saturdays	Saturdays 9 am - 12:30 pm	Saturdays 12:30 - 5 pm	Saturdays 5 - 9 pm

Other (please specify)

10. Computer Skills - Please indicate your level of knowledge

	High	Medium	Low	Dont Know
Using Windows	*Computer Skills - Please indicate your level of knowledge Using Windows High	Using Windows Medium	Using Windows Low	Using Windows Dont Know
Using the Internet	Using the Internet High	Using the Internet Medium	Using the Internet Low	Using the Internet Dont Know
Microsoft Word	Microsoft Word High	Microsoft Word Medium	Microsoft Word Low	Microsoft Word Dont Know
Microsoft Excel	Microsoft Excel High	Microsoft Excel Medium	Microsoft Excel Low	Microsoft Excel Dont Know
Microsoft PowerPoint	Microsoft PowerPoint High	Microsoft PowerPoint Medium	Microsoft PowerPoint Low	Microsoft PowerPoint Dont Know
Microsoft Access	Microsoft Access High	Microsoft Access Medium	Microsoft Access Low	Microsoft Access Dont Know
Intuit QuickBooks	Intuit QuickBooks High	Intuit QuickBooks Medium	Intuit QuickBooks Low	Intuit QuickBooks Dont Know

Other (please specify)

11. Languages - Please indicate any other languages that you speak

	Low	Intermediate	High
Spanish	*Languages - Please indicate any other languages that you speak Spanish Low	Spanish Intermediate	Spanish High
Other	Other Low	Other Intermediate	Other High

12. Experience/Other Skills - What experience(s) might have prepared you to tutor, teach, or help in other ways? What other skills might you be able to share?

Experience/Other Skills - What experience(s) might have prepared you to tutor, teach, or help in other ways? What other skills might you be able to share?

13. What do you do with your time now?

What do you do with your time now? I work full-time I work part-time I am retired	I am unemployed I volunteer
Other (please specify)

14. If you are working, please tell us where you work and what you do. If you volunteer elsewhere, please tell us where.

If you are working, please tell us where you work and what you do. If you volunteer elsewhere, please tell us where.

15. Anything else you would like us to know?
Do you belong to any groups that might wish to support Opportunity Junction?
Are you only available on certain days or at certain times?
Knowing your preferences lets us contact you for activities in which you are more likely to be able to participate.
Your comments are welcomed!

Anything else you would like us to know? Do you belong to any groups that might wish to support Opportunity Junction? Are you only available on certain days or at certain times? Knowing your preferences lets us contact you for activities in which you are more likely to be able to participate. Your comments are welcomed!

16. Do you have any criminal convictions?

Do you have any criminal convictions?

17. Personal References: Please list two people who would be willing to serve as personal references.

Personal References: Please list two people who would be willing to serve as personal references. First Reference - Name:
Phone and/or email:
How does this person know you?
Second Reference - Name:
Phone and/or email:
How does this person know you?

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18. By entering my name below, I certify that the statements made in this application are true and correct.

By entering my name below, I certify that the statements made in this application are true and correct.

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