Volunteer

Interested in volunteering? Please complete and submit this application.

Title
First Name:
Last Name:
Address
City
State
Zip
Home Phone
Bus. Phone
Cell
E-mail
AGE RANGE: Except for volunteers under 18, who are required to respond, this question is not mandatory. The information is requested for statistical purposes only.
Employment Information
Occupation
Years Employed
Current Employer
   
Employment Experience
Current:
Job Title
 
Start Date
   
Past:
Job Title
 
Start Date
End Date
In school?
yes no
last grade completed?
Degree
Volunteer Experience
Current
Organization
 
Start Date
End Date
Past
Organization
Start Date
End Date
 
Organization
Start Date
End Date
Hours Available To Volunteer
Languages Spoken Fluently
Special Skills
Have a car?
yes no
How far are you willing to drive?
Check 4 areas in which you would like to be involved:
 
Driving Meals to Hospitals/Clients Homes
 
Visiting Families in Hospitals
 
Clerical Work
 
Big Brother/Big Sister Program (weekly commitment required)
 
Home Respite - Daytime
 
Family Support Program (weekly commitment required)
 
Event Planning
 
Event Staffing
References
Name
Phone
Relationship
Name
Phone
Relationship
In Case of Emergency Notify:
First Name
Last Name
Home Phone
Cell Phone
Relationship
How did you hear about Chai Lifeline?
 
What volunteer or experiences have helped you to prepare for working with Chai Lifeline families?
Tell us about an event or experience that has had a significant impact on your life.
What qualities would you bring to Chai Lifeline that would benefit our families?
What are your expectations of being a CLL volunteer?
Have you ever been convicted of any crime, including sex-related or child abuse related offenses in any state or country? Yes No
If you have a professional license, have you ever been required to surrender your license by the licensing board or professional ethics body?
Yes No N/A
Have you ever been found guilty of violation of professional ethics codes, professional misconduct, or unprofessional conduct, in any state or country?
Yes No

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