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Volunteer Application
First Name *
Last Name *
Email *
Phone number *
Street Address *
Town/City *
Zip Code *
State *
Organization/Business
Does your organization or business have an employee program that grants donations to charitable organizations based on their volunteer hours?
Availability *
Mornings
Afternoons
Evenings
Unavailable
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Interests *
Required
Are you (Bi-lingual)? *
If yes, what languages do you speak?
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. Please indicate any financial areas of expertise or financial credentials (i.e.: degree, license, certification) obtained.
If you did not see a skill listed please provide below
Previous Volunteer Experience
Resume or Curriculum Vitae
Sex *
Age *
Ethnicity
Education *
Personal or Professional Reference
**Please provide Name, contact information (phone number & email) and relationship**
Agreement
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. I also understand that volunteers are required to complete mandatory orientation and training before and during their service to the program.
Choice
I do agree
I do not agree
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.
Please contact Barbara Steadman at bsteadman@cahs.org or (860)951-2212, ext. 244 if you have additional questions.

Thank you for completing this application form and for your interest in volunteering with us.

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