* 1. Personal Information

* 2. How would you prefer to be contacted?

* 3. What is your age range

* 4. Birthday Month

* 5. Have you ever been convicted of a crime? (You may omit minor traffic offenses, any convictions which have been sealed, expunged or statutorily eradicated, convictions more than two years old for marijuana related offenses for personal use, and misdemeanors for which probation was complete and the case judicially dismissed.) If Yes, please explain in the section provided

* 6. Education

* 7. Please describe any previous work experience that may be pertinent to your volunteer interest (Check all that apply)

* 8. Does your current employer have (check all that apply)

* 9. Have you had any previous experience as a volunteer? If so, with what organizations, and what kind of work did you do?

* 10. Are you a member of any professional, civic, or social clubs? (Check all that apply)

* 11. How did you learn about our volunteer opportunities?

* 12. Please describe your reason for volunteering with LBDA: Why, at this particular time in your life, have you chosen to volunteer with us? What do you hope to accomplish?

* 13. Generally speaking, where do you want to focus your volunteer efforts? (Check all that apply)

* 14. How long would you like to volunteer?

* 15. Date you’ll be available to start:

* 16. Please provide the first and last name and contact number for 3 references.

* 17. I certify that all information in this volunteer application are true and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation in my application or placement interview may result in the rejection of my application or discharge from the volunteer program.2. I understand that as a part of the final volunteer selection process, I may be required to provide reference and/or consent to conduct a background screening. I understand that all information collected during this background screening will be limited to that appropriate to determine my suitability for this particular type of volunteer work and that such information collected during the screening will be kept confidential.3. I understand that as a volunteer, I am offering my services of my own free will without any expectation of compensation, benefits, or insurance of any kind. Please type your complete name below as acknowledgment of the above statement. If under the age of 18, a parent/legal guardian's name is also required.

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