PAACA Volunteer Application Question Title * 1. What is your first name? OK Question Title * 2. What is your last name? OK Question Title * 3. What is your gender? Female Male OK Question Title * 4. Are you over 18 years of age: yes ____ no ____ OK Question Title * 5. What is your age? 17 or younger 18-20 21-29 30-39 40-49 50-59 60 or older OK Question Title * 6. Have you ever filed an application with us before? yes ____ no ____ If yes, give date: __________________ OK Question Title * 7. Have you ever volunteered with us before? yes ____ no ____ If yes, give date: __________________ OK Question Title * 8. Do any of your friends or relatives, other than spouse, volunteer here? yes ____ no ____ If yes, state name, relationship and location: _____________________________________ OK Question Title * 9. Do any of your friends or relatives, other than spouse, work here? yes ____ no ____ If yes, state name, relationship and location: _____________________________________ OK Question Title * 10. Are you prevented from lawfully becoming a volunteer in the USA yes ____ no ____ due to Visa or Immigration Status? [Proof of citizenship or immigration status will be required] OK Question Title * 11. Have you ever been convicted of a felony? yes ____ no ____ [Answering yes to this question does not necessarily disqualify you] If yes, please list all charges: ____________________________________________________________________________ OK Question Title * 12. Are you currently on probation or parole? yes ____ no _____ Probation Officer’s name and phone: _____________________________________________ When are you scheduled to be off probation?__________ OK Question Title * 13. Reason for wanting to volunteer here:_____________________________________________ Number of volunteer hours you would like or need: Minimum ____ Maximum hours____ Date available to start: _________ OK Question Title * 14. Work Availability: (check each day available) Monday__ Tuesday__ Wednesday __Thursday__ Friday__ Saturday(a.m.)__Sunday (a.m.)__ OK Question Title * 15. Mornings _____ Afternoons _______ Either _________ OK Question Title * 16. Which of the following categories best describes your employment status? Employed, working full-time Employed, working part-time Not employed, looking for work Not employed, NOT looking for work Retired Disabled, not able to work OK DONE