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Nassau County Volunteer Center


VOLUNTEER APPLICATION
Nassau County, Florida
(Looking for Nassau County, New York? Click here)

FIRST NAME
LAST NAME
E-MAIL ADDRESS
E-MAIL ADDRESS
(again for verification)
MAILING ADDRESS
CITY
ZIP
HOME PHONE
WORK PHONE
BEST TIME TO CALL
OCCUPATION/EMPLOYER
PREVIOUS EXPERIENCE
 (paid and/or volunteer)
EDUCATION
(select one)
AREA OF STUDY or MAJOR
DAYS AVAILABLE

Mon Tues Wed Thurs
Fri Sat Sun
HOURS AVAILABLE
If applicable, please also select one of the following.
Available On Call   Available By Appointment
GEOGRAPHIC PREFERENCE
 (if you prefer to volunteer in a specific area, please provide that zip code)
AGE 18-25  26-40  41-50  51-60  60+
TRANSPORTATION
 (How would you get to your assignment?)		 Car   Bus   Walk
Other
REFERENCE
(other than relative)
REFERENCE'S PHONE
LIMITING DISABILITIES
 (if so, please explain)
HOW DID YOU HEAR ABOUT THE NASSAU VOLUNTEER CENTER? Newspaper   Newsletter   E-Mail
Website   Other:
TYPE OF VOLUNTEER WORK PREFERRED
 (select as many as you wish)		 Administrative
Arts & Crafts
Child Care
Clerical
Criminal Justice
Cultural
Entertainment
Finance
General Office
Handicapped
Hospitals
Public Relations
Recreation
Transportation
Tutoring
Writing/Editing
Other:
WHAT GROUPS WOULD YOU PREFER TO WORK WITH?
 (select as many as you wish)		 Children (0-5)
Children (6-12)
Youth (13-18)
Adults
Aged
Retarded
Blind/Deaf
Mentally Ill
Handicapped
No Preference
CIVIL DEFENSE
 (Are you willing to be called upon by civil defense authorities in an emergency or disaster?)		 Yes      No
VOLUNTEER METHOD
 (How do you prefer to volunteer)		 Regular Basis
Community Board Bank
SkillsBank (special projects only)
SKILLS
 Please list any skills you would like us to use in short-term assignments
You must check this box.
I understand I am free to accept or refuse     placement offered.