| Applicant Information: |
| LAST NAME: |
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| FIRST NAME: |
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| MAILING ADDRESS: |
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| CITY: |
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| STATE: |
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| ZIP CODE: |
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| HOME PHONE: |
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| OTHER PHONE: |
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| EMAIL: |
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| Have you ever volunteered with JASMYN before? |
Yes
No |
Demographic Information
(Optional Questions): |
| Gender: |
Male
Female
Transgender
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| Sexual Orientation: |
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| Age: |
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| Race: |
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| Employment Information: |
| Are you employed? |
Yes
No
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| Place of Employment: |
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| Job Title: |
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| Is this work? |
Full-Time
Part-Time
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| Work Phone #: |
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| Education and Training Background: |
| High School Diploma? |
Yes
No
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| Some College? |
Yes
No
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| College Degree? |
Yes
No
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| Area of Study: |
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| Post Graduate Work? |
Yes
No
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| Area of Study: |
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| References: |
| Name: |
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| Phone: |
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| How does this person know you? |
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| Name: |
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| Phone: |
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| How does this person know you? |
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| Information for Background Checks: |
| Date of Birth: |
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Aliases or other names by
which you have been known: |
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| Have you ever been arrested? |
Yes
No |
If yes, please give date of arrest,
reason, State (i.e.Florida) arrest occurred in and outcome: |
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Have you ever been convicted, plead
guilty, nolo contendere, or had adjudication withheld for a crime? |
Yes
No
|
If yes, please give date, the criminal
charge, and State (i.e. Florida) where convicted: |
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| Personal Interest: |
| Why are you interested in volunteering with JASMYN? |
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What other volunteer work have you
done that may assist you at JASMYN? |
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| What programs or activities are you interested in helping with? |
| Peer Support Groups Facilitator: |
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| Gay Youth Information Line Worker: |
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| Youth Drop In Center Worker: |
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| Other Youth Activities (Describe below): |
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| Mentoring - School Safety Project: |
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| Fundraising: |
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| Board of Directors / Committees: |
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| Other(describe): |
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I certify to the best of my knowledge and belief that all of the statements contained herein are true, correct, complete, and made in good faith. I understand that JASMYN retains the right to conduct criminal background checks prior to my approval as a JASMYN volunteer.
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