Volunteer Application

Please Download the Following Volunteer Application:

Volunteer Application

To Return Application via mail:

Nicki Johnston

Volunteer Application

Thank you for your interest in helping Cops Fighting Cancer! It takes a team of dedicated volunteers to make a difference in the lives of cancer patients and their families. We appreciate you and your support!

Please read each question carefully and print each answer clearly. You must complete this entire form. Email/mail completed applications to Nicki Johnston at the address below. Nicki will contact you once your packet is received to schedule a volunteer orientation. As always, you are welcome to call or write with questions, concerns, ideas, good stories… we’d love to hear from you!

Personal Information

Name: _____________________________________________________

Date: _____________________

Home Phone: ______________________

Cell Phone: ________________________

Street Address: _______________________________________________________________________City ___________________________________ State ___________________ Zip___________

E-Mail Address _______________________________________________________________________

Last four digits of SSN: ________________________________________

Date of Birth: _____________

Emergency Contact: ________________________________________

Phone: ______________________

Previous Address (or permanent address if a student): __________________________________________

City __________________________________

State: ______________ Zip _________

Employment Information

Current Employer: ___________________________________

Job Title: ____________________________

Work Phone: ______________________________

Work E-Mail __________________________________

Work Address:___________________________________________________________ How long at current job? ________________________________

Can we contact you at work?            YES            NO

Three Personal References – Non Relatives

Name___________________________________________

Phone Number____________________________________

Years Known/Relationship__________________________

Name___________________________________________

Phone Number____________________________________

Years Known/Relationship__________________________

Name___________________________________________

Phone Number____________________________________

Years Known/Relationship__________________________

Security Information

Have you ever been convicted of, or served time for, a felony? If so, please describe below. This information will remain confidential.

Incident__________________________________________

City/ State________________________________________

Charge___________________________________________

Special Skills

Experience working with children: ______________________________________________________________________________________________________________________________________________

Related Office Skills:

______________________________________________________________________________________________________________________________________________

Personal Skills/Hobbies (First Aid, Life Guard, etc.):

______________________________________________________________________________________________________________________________________________

List other volunteer experiences:

______________________________________________________________________________________________________________________________________________

Languages other than English: ____________________________________________________________

Do you have a valid Colorado Driver’s License? YES NO If so, valid DL #:______________State: ____

Availability & Interest

Please mark the days and times that you are available with an “X” and/or hours of availability:

Please circle the ideal number of days you’d like to volunteer each month:

1.            2.            3.            4.            5.            6.            7.            8.            9.            10.            More than 10

Please rank the following volunteer opportunities in order of preference with 1 being the highest level of interest and 3 being the lowest level of interest.

_________Special Event Volunteer _________Office/ Admin Volunteer _________Outgoing/ Activities Volunteer Maintenance Technician Other

Referred By (Name): ____________________________________________________________________

1 – Self            2 – Volunteer            3 – Media            4 – Friend            5 – Employee            6 – Other

Personal Release

I certify that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my volunteer service. I authorize Cops Fighting Cancer and/or its agents, including consumer- reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand the use of illegal drugs and smoking is

prohibited during volunteer service.

Signature: ____________________________________________________

Date: ___________________

Parent/ Guardian Signature (If under 18): ____________________________________________________

njohnston@copsfightingcancer.org