Christian Education and Development Organization

                                                 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?

   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

Mkristo Elimu na Shirika la Maendeleo la

Siri

Kujitolea MAOMBI

(Tafadhali Print)

Ufunuo 2012/12/06

Jina: _______________________________ _________________ Tarehe: ________________

(Mwisho) (Kwanza) (Kati)

Anuani: __________________ Jimbo: ___________ Zip: ____________

Mailing mitaani (kama ni tofauti): ____________________ City: _______ Jimbo: ____ Zip: _____

Simu ya Nyumbani: ________ Kazi Simu: _______________________

Kiini _________________ Fax: (___) _________________________

E-Mail: ____________ Mei tunaita wewe katika kazi? ____

Tarehe ya Kuzaliwa: ____ Je, wewe zaidi ya 18? ______

(Mo) (Siku) (Mwaka Optional)

Dharura Mawasiliano:

Jina: ___________ Simu _________________

Uhusiano: ______________________________

Medical habari tunapaswa kujua katika kesi ya dharura: ________________________

o Ulisikia kuhusu CEDO?

___________________________________________________________________________

o Kwa nini ni wewe nia ya kujitolea kwa CEDO?.

__________________________________________________________________________

o Je, awali alijitolea hapa? _______

Kama ndiyo, katika kile msimamo? __________________________________________________

I. Elimu / Ajira / Huduma kujitolea Background

Elimu

o juu ya kiwango cha Elimu: ___________________ Meja? ____________________

o Je, wewe ni mwanafunzi wa sasa? ____ Kama ndio, jina la shule: _______________

Daraja ________________________________________

Ni kujitolea uzoefu inavyotakiwa na mpango wako? Ndiyo _______

Kama ndiyo, eleza: _____________________________________________________

Ajira

o Mwajiri (Hali): ________________ Msimamizi: _________________________

Nafasi uliofanyika: _________________________ Simu: _________________

Anuani: __________ City: ______________ Jimbo: ____________ Zip: _______

Tarehe kuajiriwa: ____________________________________________________

o Mwajiri (Previous): _________________ Msimamizi: _________________________

Nafasi uliofanyika: _____________________ Simu: (___) __________________________

Anuani: _______________ Jina: _____________ Jimbo: ________ Zip: ___________

Sababu ya kuondoka: __________________________________________________________

Tarehe kuajiriwa: Kutoka _________________ kwa ________________________________.

Jitolee Uzoefu

o Je, una mengine kujitolea uzoefu? ______________________________________________

Tafadhali kuelezea aina na kiasi cha uzoefu uliopita:

Organization: _______________________ Tarehe ya Huduma: Kutoka ________ kwa ________________

Maelezo ya majukumu: ____________________________________

Organization: _________________ Tarehe ya Huduma: Kutoka ______________ kwa __________________

Maelezo ya majukumu: ________________________________________________________________

o Jumuiya ya kampuni tanzu: (Jina & zinaonyesha aina ya kuhusika)

Clubs____________________________________________________________________

Huduma Mashirika _______________________________________

Professional Mashirika / Boards____ _________________________________________

Kanisa _______________________________________

Nyengine ____________________________________________________________________

II Stadi. Na Maslahi

o Je, ni Hobbies yako na / au maslahi maalum? ________________________________________________________________________

o gani mahususi ujuzi na uzoefu wa maisha ingekuwa wewe kuleta...