Lansing Area AIDS Network Volunteer Application
APPLICANT INFORMATION
Name: First, Middle, Last *
Your answer
Pronouns
Your answer
Address, City, State, Zip Code *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Email *
Your answer
EMERGENCY CONTACT INFORMATION
Emergency Contact Name (First, Last) *
Your answer
Emergency Contact Primary Phone Number *
Your answer
Emergency Contact Secondary Phone Number
Your answer
EDUCATIONAL INFORMATION
Are you currently enrolled in school? *
If yes, where?
Your answer
Are you seeking hours as part of a school program?
If yes, how many hours?
Your answer
When do hours need to be completed?
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EMPLOYMENT INFORMATION
Are you currently employed? *
If yes, where?
Your answer
What are your work hours?
Your answer
VOLUNTEER EXPERIENCE
Volunteer Organization 1:
Your answer
Date volunteer from:
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Date volunteered to:
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Currently Volunteering at this organization?
Describe your volunteer experience:
Your answer
Volunteer Organization 2:
Your answer
Date volunteered from:
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DD
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YYYY
Date volunteered to:
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Describe your volunteer experience:
Your answer
GETTING TO KNOW YOU
How did you learn about volunteer opportunities with LAAN? *
Your answer
Name of individual who recruited you so we may thank them:
Your answer
What has motivated you to seek volunteer opportunities with LAAN? *
Your answer
What do you wish to achieve in your volunteer experience? *
Your answer
What skills do you have that you would like to share with LAAN? *
Your answer
Describe your feelings about the HIV/AIDS epidemic and its effect on you. *
Your answer
Do you consider yourself knowledgeable about the following? *
Required
How would you like to be recognized for your service? (Pick up to two options) *
Required
AVAILABILITY
Are you able to commit at least one year of service? *
How often are you available to volunteer? *
What hours are you available to volunteer? *
Required
What day(s) of the week are you available to volunteer? *
Required
Volunteer position first choice: *
Volunteer position second choice: *
CRIMINAL BACKGROUND CHECK
Please indicate if you have ever had a conviction for a misdemeanor or charged with a felony *
If yes, please explain:
Your answer
I hereby willingly consent to the completion of a background investigation and authorize Lansing Area AIDS Network and/or its agents to request from any individual, company, firm, corporation, or public agency, including bona fide law enforcement agencies, any records or information pertaining to me. I further authorize any individual, company, firm, corporation, or public agency, including bona fide law enforcement agencies, to divulge any and all information, verbal or written, pertaining to me, including information or data received from other sources to Lansing Area AIDS Network and/or its agents.It is my understanding that any information obtained in the course of the background investigation will be held strictly confidential by Lansing Area AIDS Network and its agents. Information gathered will be used on in connection with the volunteer application and placement process. I hereby authorize Lansing Area AIDS Network and/or its designated agents and representatives to conduct a comprehensive review of my background, which may include information concerning my criminal, motor vehicle, and other history.I understand this authorization automatically expires 90 days from the date executed below and that I have the right to revoke this authorization at any time, provided I do so in writing to Lansing Area AIDS Network. Do you agree? *
Full Name (First, Middle, Last) *
Your answer
Have you had a name change within the last 7 years? *
Please list any other name(s) used within the last 7 years: *
Your answer
Date of Birth *
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Gender: *
Your answer
My typed name shall have the same force and effect as my written signature. Full name below: *
Your answer
Today's Date *
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Time application completed *
Time
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THANK YOU
Thank you for taking the time to complete this application. Your responses will be sent directly to the Volunteer Coordinator, Shawn Marie Hunter. Please allow a week for a response to your application. If selected for an interview, please come with two references prepared.
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