Home Phone (+ area code):Ex: (555) 555-5555
Work Phone (+ area code):Ex: (555) 555-5555
Cell Phone (+ area code):Ex: (555) 555-5555
Date of Birth:Ex: 9/5/1955
Place Of Employment:
Area Of Study:
Hispanic or Latino
If other ethnicity, please describe:
Other languages you speak:
Other Relevant Experience:
Hobbies/Special Talents and Interests:
Days Available to Volunteer:
Times Available to Volunteer:
English as a Second Language
Below Sixth Grade Level Reading/Math
Assisting w/Volunteer Training
Please explain why you are interested in becoming an Adult Education volunteer:
Can you make a minimum commitment of six months to the volunteer program? *
Name of person to contact in case of emergency:
Day Phone (+ area code):Ex: (555) 555-5555
Evening Phone (+ area code):Ex: (555) 555-5555
Have you ever been convicted of a felony? *
If you answered yes, please explain (include offense, conviction date and jurisdiction of conviction):
(Note: No applicant will be denied solely on the grounds of a conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered.)
Are you currently on probation and/or parole?
If you answered yes, please explain if there any conditions of your probation/parole that would prohibit your volunteering at OTC.
What physical conditions should be taken into consideration in arranging a volunteer assignment for you?
Please submit two non-family references (friend, employer, co-worker, etc.)
Phone (+ area code):Ex: (555) 555-5555
How did you learn about volunteering with Adult Education and Literacy?
May we use photographs of you in brochures, promotional pieces, etc.?
As a volunteer, I understand that I am not an employee of Ozarks Technical Community College, the Adult Education and Literacy program or the volunteer class site.
I Do Not Agree
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