PSCDC: Volunteer Application
Please fill out this form to apply as a PSCDC volunteer. Please fill out all questions even if they are not required. For required questions that do not apply to you, please enter "N/A".
Contact Information
Full Name *
Your answer
Street Address *
Your answer
City, State, ZIP *
Your answer
Home Phone *
Your answer
Work Phone
Your answer
Email Address *
Your answer
Availability
During which hours are you available for volunteer assignments? *
Required
Interests
What areas are you interested in volunteering *
Required
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. *
Your answer
Previous Volunteer Experience
Summarize your previous volunteer experience.
Your answer
Person to Notify in Case of Emergency
Full Name *
Your answer
Street Address *
Your answer
City, State, ZIP *
Your answer
Home Phone *
Your answer
Work Phone *
Your answer
Email Address *
Your answer
Transportation
Do you have access to a car? *
If yes, do you have insurance? *
Insurance Company Name/Policy # *
Your answer
Driver's License State and Number *
Your answer
Felony Status
Have you ever been convicted of a felony? *
If yes, please explain: *
Your answer
Agreement and Signature
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 in signing this, PSCDC is authorized to run a Background Check on me.
Full Name (This will be your signature) *
Your answer
Date *
MM
/
DD
/
YYYY
Parent Signature (if under 18)
Your answer
Our Policy
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.

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

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