General Volunteer Information from the Nassau Center

Only applications from Nassau County, North Florida can be accepted. Thank you.

First Name
Last Name
Address
Address
City
State		Zip Code

E-Mail Address:

Confirm E-Mail Address

Home Phone Number		Work Number
Best Time To Call (check one)	Before 12 p.m.	After 12 p.m.

Occupation/Employer
Work Experience (please explain briefly)

Education
Area of Study or Major

Days Available for Volunteering (check as many as you wish)	Monday's Tuesday's Wednesday's Thursday's Friday's Saturday's Sunday's Any Weekday Any Weekend	Hours Available for Volunteering (check as many as you wish)) If applicable, please check one of the following:	Morning's Afternoon's Evening's Any Time Available On-Call Available By Appointment

Geographic Preference (If you prefer to volunteer in a specific area, please provide that zip code)

Your Age	18-25 26-40 41-50 51-60 61+	Transportation (How would you get to your assignment?)	by Car by Bus with a Bike Walk Other
		If you selected other please explain:

Reference (other than relative)
Reference Phone #

Limiting Disabilities (if so please explain)

How did you hear about the Nassau Volunteer Center? (please check)		Newspaper Newsletter	Email Web site	Friend

Type of Volunteer Work You Prefer (check 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? (check 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? (Check one)			Yes	No

Volunteer Method How do you prefer to volunteer? (Check one)		Regular Basis Community Board Bank SkillBank (special projects only)
		Skills: Please list any skills you would like to use in short-term assignments.


I understand I am free to accept or refuse placement offered. You Must Check This Box

Contact: (904) 261-2771

email: ncvcfb@aol.com