Volunteer Application Personal InformationName* First Last Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employer / SchoolEmergency ContactPlease include telephone numberMotivationWhat reason(s) best describe your reason for wanting to become a volunteer: A desire to help others Class assignment Scholarship Court Ordered Other Other - Please DescribeAvailabilityAM - 8am-12pm; PM - 12pm-4pmPreferred Morning Shifts Sunday Monday Tuesday Wednesday Thursday Friday Saturday Preferred Afternoon Shifts Sunday Monday Tuesday Wednesday Thursday Friday Saturday Personal or Professional ReferencesApplications will not be processed without 2 complete references (Please exclude relatives. Minors should include a teacher, pastor, scout leader or other authority you have worked with.)Reference 1 - Name* First Last Reference 1 - Phone*Reference 1 - Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 2 - Name* First Last Reference 2 - Phone*Reference 2 - Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Experience / Special SkillsPlease use this area to describe your previous volunteer experience as well as any special skills you may bring with you to this volunteer position.AgreementBy submitting this application, I affirm that the facts set forth in it are true and complete. If you are 18 years of age or older, submitting this application indicates your approval for staff of the Tulsa Day Center to verify your references and perform a criminal background check. The Tulsa Day Center is not obligated to provide a volunteer placement nor are you obligated to accept the offered volunteer position. It is the policy of the Tulsa Day Center to offer equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age or disability.Confirm* I have read and understand the agreement above. NameThis field is for validation purposes and should be left unchanged.
