xRV CAV DR Application April 2019 Survey

1.Please provide your personal information.(Required.)

Last Name:

First Name:

Middle Initial:

Preferred Name:

Email Address:

Address:

Address 2:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Cell Phone:

Care-A-Vanner rig type:

Tee Shirt Size

2.What is your background with Habitat for Humanity besides the RV Care-A-Vanner (please check all that apply.)

Global Village Participant

Global Village Team Leader

Affiliate Board/Staff

Habitat for Humanity International Staff

Affiliate Volunteer (please specify which affiliate in Other box)

None

Other (please specify)

3.Please list your experience with the RV CAV program.

Number of scheduled builds:

Number of team leads:

4.Do you have construction experience outside of Habitat?

Yes

No

If yes, please specify.

5.Do you have experience with your home affiliate?

Yes

No

If yes, please specify.

6.Please list one personal and two professional references (may be fellow RV CAV.) (Required.)

NAME

Telephone (include Country code for a non-US phone number)

Email Address

Nature of Relationship

Number of Years Known

NAME

Telephone (include Country code for a non-US phone number)

Email Address

Nature of Relationship

Number of Years Known

NAME

Telephone (include Country code for a non-US phone number)

Email Address

Nature of Relationship

Number of Years Known

12.Please list any licenses or certifications you hold that related to the areas of expertise identified in Questions 5 - 9.

13.Please describe any community or volunteer work you've done that is relevant to the Disaster Response.

14.Please identify any past job experience that is pertinent to doing Disaster Rebuild work.

15.Are you fluent in any languages besides English?

16.Please list any geographical preferences within the United States for Disaster Response deployment.

18.Are there any health or dietary considerations that might affect your work or placement within the RV CAV Disaster Response?

Yes

No

If yes, please specify.

19.Please tell us why you are interested in being a part of the RV CAV Disaster Rebuild Team.

20.Please share any additional information not covered in this form that will strengthen your application.

Thank you for taking the time to complete this survey. Optional: If available in an electronic format, please send your resume to mvandeveld@habitat.org.