KairosPDX Ambassador Service Application
Name: *
Address:
Phone Number(s) *
Date:
MM
/
DD
/
YYYY
Email Address: *
Are you bilingual?
What language?
Sign language?
How did you hear about KairosPDX?
Most recent or current volunteer experience:
Are you willing to complete a background check with Oregon State Police, Department of Education, and/or Fingerprint if needed?
If no, explain:
Are you a veteran?
Are you currently attending school?
School name:
Year in school:
Name and address of your high school:
What years did you attend high school?
Did you graduate?
Did you attend college?
If yes, did you graduate? With what degree?
Please Provide at least one personal or professional reference: *
Name and contact information
Please describe previous employment/volunteer experience (company, responsibilities, time frame, reason for leaving, contact information for supervisor)
May we contact your previous supervisor for a reference?
Clear selection
Please describe any relevant experience you may have: *
Examples: teaching, working with kids, marketing, grant writing, communications, gardening, graphic design
If you are applying for a specific position, please list it below:
Do you have other volunteer commitments? If so, please list/describe below:
Approximately how many hours per week can you commit to volunteering?
What length of time can you commit to volunteering with KairosPDX?
Please check all time slots when you would generally be available to volunteer or for meetings:
(Volunteers may not meet regularly; this is only to get an idea of availability PLEASE WRITE IN BOX BELOW IF YOU CAN'T CHECK GRID)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8-10am
10-12pm
12-2pm
2-4pm
4-6pm
6-8pm
Clear selection
Comments? Questions?
Thank you so much for your interest in volunteering! With your help, we can continue to keep children safe and families together. I understand that false or misleading information in my application may result in my release. Please type your name below as your signature.
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