2394 Morrison Road 
Conyers, GA 30094 
P: 770.483.3535 
F: 770.483.5696 
 

VOLUNTEER APPLICATION

Please complete the form below or download the application, print, complete and then fax to Dawn Butler at 770-483-5696. If you have any questions, feel free to contact us directly at 770-483-3535.

Date of Application:
PERSONAL INFORMATION:
  
Name:
Address:
City:
State/Zip:
   
Home Phone Number:
Cell Phone Number:
Email:
EMPLOYMENT:
 
Employer Name/Address:
Job Title:
EDUCATION:
  
Please choose the highest grade completed:
 Grade:
7  8  9  10  11  12    
College:
1  2  3  4 5 6
High School Name/Address:
College Name/Address:
List Majors/Minors (if applicable):
Special training, skills and/or hobbies:
COMMUNITY INVOLVEMENT:
  
List groups, clubs and/or organizations that you are presently a member of:
Volunteer Interest and Experience:
Which of the following areas
would you like to participate? 
(Check all that apply):

Public Relations
Mentoring 
Project Coordinator
Tutor 
Field Trips
Gardening
Cooking
Fundraising
Carpentry/ Minor Construction
Plumbing
Motivational Speaker
Other:
Volunteer Experience/Years Involved:
Volunteer Availability:
Monday
Tuesday  
Wednesday
Thursday  
Friday
Saturday
Sunday
Time:
am/pm
REFERENCES:
 Please list four references
(1 family member, 1 personal friend and 2  work references)
Reference #1
  
Name:
Address:
City:
State/Zip:
   
Home Phone Number:
Work Phone Number:
Relationship:
Reference #2
  
Name:
Address:
City:
State/Zip:
   
Home Phone Number:
Work Phone Number:
Relationship:
Reference #3
  
Name:
Address:
City:
State/Zip:
   
Home Phone Number:
Work Phone Number:
Relationship:
Reference #4
  
Name:
Address:
City:
State/Zip:
   
Home Phone Number:
Work Phone Number:
Relationship:
CERTIFICATION:  

By submitting this form, I certify, to the best of my ability, that the information provided on this application is true and accurate.  I also understand that misinformation knowingly provided here, and on subsequent volunteer information forms, is grounds for dismissal.

Contact for Questions or Info: Dawn Butler (770-483-3535)
Thanks for your support!

 

© Elks Aidmore | Site Design: auntie momo designs