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* 1. Name

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* 2. Contact Information 

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* 3. Were you referred to the Cumberland County Public Health Department by anyone?

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* 4. Have you ever worked for Cumberland County Government?

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* 5. When are you available to volunteer (select all that apply)?

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* 6. Times available to volunteer (select all that apply)

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* 7. Please check the highest level of education completed

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* 8. Major field of Study

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* 9. Current or most recent employer

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* 10. Position Held

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* 11. Employment period

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* 12. I am interested in volunteering for (*vaccinating, traffic control, data entry, call center) 

*copy of current license or certification required to perform vaccinations

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* 13. Job Related Skills

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* 14. Do you speak Spanish?

Thank you for your interest in volunteering. We will review your information to determine how we can use your support. After a placement has been designated, you will be required to complete a background check authorization, information release and confidentiality forms.  
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