Name - first/last (required):

Email (required):

Phone (required):

Address:
Street: City:

State: Zip:

Volunteer Experience - Please answer the following questions about your prior volunteer and work experience.

Special Training, Skills, Hobbies, Languages Spoken

Groups Clubs Organizational Memberships

Describe your prior volunteer experience. (include organization, names and dates of service)

Why do you want to volunteer? What do you want to gain from this volunteer experience?

Do you have a drivers license? Yes No 

Are you willing to commute to YFSA or community locations? Yes No 

I can begin volunteering on (M/D/Y)

Interests - Please select all the options that may interest you in your volunteer work.
Event Planning Community Outreach Special Events Gardening/Maintenance Help Me Grow Outreach Universal Screenings General/Everything Clerical Work 

References

1. First Name: Last Name:


Address: City/State/Zip:


Phone:

2. First Name: Last Name:


Address: City/State/Zip:


Phone:

3. First Name: Last Name:


Address: City/State/Zip:


Phone:

Are you 18 years or older?  Yes No

Have you ever been convicted of a criminal offense? If so, what was it?

Please read the following carefully before signing this application:

I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Yolo Family Service Agency that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Yolo Family Agency. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Yolo Family Service Agency or my termination as a volunteer.
Yes  - I have read and understand the above paragraph.

Name: Date: (M/D/Y)