Aeon Volunteer individual application

Name * First Middle Last

Home Address *

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Phone * ### - ### - ####

Mobile Phone ### - ### - ####

Preferred Email *

Employer and Position

Work Address (if applicable)

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Work Phone ### - ### - ####

Work Email

Preferred avenue of contact

Work Home

Are you 18 years of age or older?

Yes No

Please sign me up for the following Aeon information:

Aeon newsletters (twice a year) Aeon's e-news (six times a year) Aeon volunteer update (four tmes a year)

Does your employer match your volunteer hours with donations of money or in-kind services?

Yes, please contact me No

Experience and Availability

Which position are you interested in or what type of volunteer work would you like to do? *

Please list any training or formal education you have had for the position you are interested in.

Are you presently attending school?

Yes No

Will you receive academic credit for your volunteer work?

Yes No

Are you volunteering based on a court order? If yes, how many hours are required?

Are there any physical limitations you have that would affect the type of work you could do at Aeon? If yes, please specify.

Have you ever been convicted of a felony or a drug possession? If yes, please specify.

What days of the week and times during the day are you available to volunteer?

How many hours a week or month would you like to volunteer?

How long would you like your initial commitment to be?

What skills would you like to use in your experience as a volunteer?

Why do you want to volunteer with Aeon?

How did you learn about volunteering at Aeon? *

Emergency Contact information

Emergency Contact Name 1 First Middle Last

Emergency Phone 1 ### - ### - ####

Emergency Contact Name 2 First Middle Last

Emergency Phone 2 ### - ### - ####

Please provide us with three contacts to be used as personal references, two of whom should not be relatives. We do not contact personal references until we have interviewed you and informed you that we will be contacting them.

Reference #1 Name First Middle Last

Reference #1 Address

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Reference #1 Daytime Phone ### - ### - ####

Reference #1 Email

Relationship to Reference #1

Reference #2 Name First Middle Last

Reference #2 Address

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Reference #2 Daytime Phone ### - ### - ####

Reference #2 Email

Relationship to Reference #2

Reference #3 Name First Middle Last

Reference #3 Address

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Reference #3 Daytime Phone ### - ### - ####

Reference #3 Email

Relationship to Reference #3

*

I verify that the answers and information given in this application are true and complete to the best of my knowledge. I understand that if it is not, I am disqualifying myself for a volunteer position. I also understand that I am applying for a volunteer position and that this is not an aplication for, or contract of, employment. I authorize the above references to give Aeon any pertinent information they may have for the purpose of a personal reference. I authorize Aeon to investigate all statements contained there in.

Signature (note: volunteers under the age of 18 will need to provide written permission to act as a volunteer from their parent/legal guardian).

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Online Individual Application

Experience and Availability

Emergency Contact information