Christian Education and Development Organization
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Confidential
VOLUNTEER APPLICATION
(Please Print)
Rev. 12/06/2012
Name: ________________ _______________ _________________ Date: ________________
(Last) (First) (Middle)
Address: ______ ____________ State: _ __________ Zip: ____________
Mailing Address (if different): ____________________ City: _______ State: ____ Zip: _____
Home Phone: ________ Work Phone: _______________________
Cell _________________ Fax: (___)_________________________
E-Mail: _ ___________ May we call you at work? ____
Birth Date: ____ Are you over 18? ______
(Mo.) (Day) (Year Optional)
Emergency Contact:
Name: ___________ Phone _________________
Relationship: __ ____________________________
Medical information we should know in case of an emergency: ________________________
o How did you hear about CEDO?
___________________________________________________________________________
o Why are you interested in volunteering with CEDO? .
__________________________________________________________________________
o Have you previously volunteered here? ___ ____
If yes, in what position? __________________________________________________
I. Education/Employment/Volunteer Service Background
Education
o Highest level of Education: _ __________________ Major? ____________________
o Are you a current student? ____ If yes, name of school: _______________
Grade ________________________________________
Is volunteer experience required by your program? Yes ___ ____
If yes, please explain: _____________________________________________________
Employment
o Employer (Current): _ _ ______________Supervisor: _ ________________________
Position held: _________________________ Phone :_________________
Address: __ ________ City: ______________State: ____________Zip: _______
Date employed: ____________________________________________________
o Employer (Previous): _________________Supervisor: _________________________
Position held: _ ____________________ Phone :(___)__________________________
Address: _______________ City: _____________ State: _ _______Zip: ___________
Reason for leaving: __________________________________________________________
Dates employed: From _________________ to ________________________________.
Volunteer Experience
o Do you have other volunteer experience? ______________________________________________
Please describe type and amount of previous experience:
Organization: _______________________Dates of Service: From ________ to ________________
Description of duties: ____________________________________
Organization: _________________Dates of Service: From ______________ to __________________
Description of duties: ________________________________________________________________
o Community affiliations: (Name & indicate type of involvement)
Clubs____________________________________________________________________
Service Organizations_______________________________________
Professional Organizations/Boards____ _________________________________________
Church _______________________________________
Other ____________________________________________________________________
II. Skills and Interests
o What are your hobbies and/or special interests? ________________________________________________________________________
o What specific skills and life experiences would you bring to CEDO as a volunteer?
________________________________________________________________________
o Specialized skills which you would like to contribute:
____ Phone calling ____ Equipment repair ____ Crafts
____ Word processing ____ Photography ____ Decorations
____ Mailings ____ Public Relations ____ Graphic Design
____ Computer tech. ____ Writing/editing ____ Entertainment
____ Errands ____ Fundraising ____ Speaking
____ Sign Language ____ Special Events - Specify: _______
____ Foreign Language - Specify: ____________________________________________
____ Other - Specify: ______________________________________________________
o Do you hold any special certificates? (e.g. CPR, First Aid, Lifeguard, Defensive
Driving). No ___ YES_______ If yes, please indicate the type of license and an
expiration date ____________________________________________________________
III. Preferences in Volunteering:
o Upon reviewing our "Volunteer Opportunities, do you have a sense of an area at CEDO
you would like to be involved in? ________ _________________________________
__________________________________________________________________________
o Do you have any limitations (family commitments, health, etc.) which might affect
your volunteering? _____ If yes, please explain. ______________________
__________________________________________________________________
o Have you ever been convicted of a criminal offense? _________________If yes, please
explain: ____________________________________________________________
o Can you make a commitment to this program for at least a year? __________________________
If no, please explain. ________________________________________________________
o At what times are you interested in volunteering?
Am flexible _ Prefer weekdays ____ Prefer evenings ____
Prefer weekends ____ Prefer days ____ Other: ____________
If you are applying to volunteer in the “Friend-to-Friend” or “Circle of Friends” program, please answer the following questions:
o Is there a particular group with whom you are particularly interested?
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No Preference ____ Developmentally disabled Physically disabled ____
o Would you be comfortable volunteering with someone who is: ____ deaf; ____ blind;
____ wheelchair bound; ____ non-verbal; ____ development level much lower than their age.
o Is there any type of disability with which you would not feel comfortable working?
No If yes, please specify: _______________________________________
~ Are you allergic to pets? _____________________ Please specify: ______________________
~ Do you smoke? __________Are you willing to volunteer with someone who smokes? _____
o Do you have any geographic preference as to where you do volunteer work?
____________ If yes, please specify: _______________________________________________________
IV. Transportation (Complete if this will be part of your volunteer service)
o Do you drive? No __
If yes, are you willing to use your automobile for volunteer service? No ____Yes ____
(If yes, please attach a copy of your driver's license and proof of current auto insurance,
including passenger liability.)
o If you have had a moving violation or motor vehicle accident in the past 5 years, please describe.
__________________________________________________________________________
o Have you ever have had any motor vehicle license suspended or revoked?
_________________ If yes, please describe: ____________________________
__________________________________________________________________________
IV. References and Background Checks:
o Please list three (3) people who are NOT CEDO STAFF or RELATED TO YOU
who know you well that we can contact for a reference check.
Personal References
1. Name: ______________________________________________________
Nature of Relationship: ______________________ Length of time known: ___________________________
Home phone _______________________Work phone ________________ Email ___________________
2. Name: ______________________________________________________
Nature of Relationship: ______________ Length of time known: ______________________________
Home phone ______________-Work phone ______________ Email ________________________________
Employer/Supervisor Reference (Someone you have worked with including employers
or supervisors in a paid or volunteer position. If you have never had a supervisor, please list
an additional personal reference)
Name: ____________________________________________________________
Business/Organization: _________________________________________________________________
Home phone _________________Work phone ____________ Email ________________________
I certify that the information set forth in this application is true and complete to the best of my knowledge. I understand that if I am accepted as a volunteer, Bridge Disability Ministries may end that relationship, if I have made any false statements or misrepresentations in this application. I authorize CEDO to verify all information contained in or related to this application, including records of law enforcement agencies, references, employment and/or volunteer history.
I understand that information collected during this background check will be limited to that appropriate to helping determine my suitability for particular types of volunteer work and that all such information collected during the check will be kept confidential. I hereby also extend my permission to those individuals or organizations contacted for the purpose of this background check to give their fill and honest evaluation of my suitability for the described volunteer work and such other information, as they deem appropriate. (Questions asked during the reference check are available to review if you so choose.)
Signature: _________________________ Date: _____________________
Thank you for your time in completing this application!
We deeply appreciate your willingness to share yourself, your time and talents
with the persons CEDO serves and to experience their gifts in return.
Please mail your application to CEDO, Volunteer Coordinator
Christian Education and Development Organization
P.O.Box 545, Nzega-Tabora-Tanzania
Tel +255 26 269 2493, Mobile +255 755 565 893
Email Address:- cedsorg@yahoo.com