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Autism Society of Colorado Volunteer/Unpaid Intern Application
(Use for DVR Staffing)
Last Name
Your answer
First Name
Your answer
Home Address
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City
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State
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Zip Code
Your answer
Email Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
Emergency Contact Relationship
Your answer
Birthday Month/Day/Year
MM
/
DD
/
YYYY
Is it okay to get calls at work?
What is the best way for us to communicate with you?
Employer/Company Name
Your answer
Occupation
Your answer
Does your employer have a matching gift program?
Please describe the products and/or services offered by your company:
Your answer
How did you hear about Autism Society of Colorado
Your answer
What is your knowledge of Autism?
Your answer
Please explain any personal connection you may have with Autism.
Your answer
What does inclusion, diversity and employment first mean to you?
Your answer
If you are currently a student, where?
Your answer
Why are you interested in becoming a volunteer?
Your answer
Please list any other agencies you are currently volunteering for?
Your answer
Please list any relevant work, educational, volunteer or other experience:
Your answer
Please list any special training, skills and/or hobbies:
Your answer
Have you ever been convicted of or pled guilty to a crime, excluding a minor traffic violation? (Note: Driving Under the Influence (DUI) and Driving While Intoxicated (DWI) are not minor offenses and must be reported.) If yes, please explain the nature of the crime and the date of conviction and disposition. (Conviction of a crime is not an automatic disqualification for volunteer work):
Your answer
Speak another language other than English.
Your answer
REFERENCES
Please list two references that can attest to your character, skills and dependability.
Reference 1 (Name and Phone)
Your answer
Reference 2 (Name and Phone)
Your answer
Do you have a vehicle that you would use for volunteering?
What areas of expertise can you contribute. Check all that apply.
What is your availability to volunteer?
Acknowledgment and Waiver: I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the volunteer selection process, including on this application and in interviews with ASC that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not withheld and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that the information contained on my application may be verified by ASC and I hereby give permission for ASC to contact anyone it deems necessary to investigate or verify any information provided by me to discuss my suitability for a volunteer position, including my background, volunteer experience, education or related matters. I voluntarily and knowingly waive any and all rights to bring an action or claim under statute or common law based on or arising from ASC’s investigation of such information, including actions or claims against ASC or against anyone providing information to ASC (including, but not limited to claims for defamation, invasion of privacy, or similar cause of action). I understand that misrepresentations or omissions may because for my immediate rejection as an applicant for a volunteer position with ASC or my disqualification from providing any further services as a volunteer.
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