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Unformatted text preview: - TEEN
APPLICATION W.» 4/ “it?! l" L M’?’ PRIME tit/(Git ‘i’i’irb‘i' mI '7 "3/ 1%”; 7+“ [1“a.’<.-'i:»ri,l' r f. l "u / - . ’. ’E'u"
(Please Print) . ,1 “A” L“. | H y
1. Last Name First Name MI
2. Address City ZipCode 3. Telephone#( ) / Email Hf}:"_ Age (optional) check one [:1 14 I: 15 I: 16 [:I 17 Q.” Educakcn: (check highest grade completed) I: High School |:] College; \ - - t - 3‘
Special "ﬁtting, Licenses, or Certiﬁcates
\6 Fluent Langu Read |:IWrite DSpeak gis (other than English) -
\JK' Days and Times ﬂable (Please check day(s) and indicate time availaﬁe) D Monday . . D Thursday,
|:' Tuesday '5 El \. Cl Wednesday Dﬁaturday o; Sunday
:8: Desired Length of Assignment: [3 3‘\fnonths E] - onths I: 9 months I: 1-year I:
“’97 Do you have any limiting conditions that m\ay\imp'air your performance as a volunteer? No El Yes (please explain) I)“ Work Experience: (Current Employer) Name Telephone Address A ‘ f:- Hours per week if. Interests / Hobbies (reading, sport-ts, etc.) ~12.” Transportation: [:1 Car Bus ,EI BART [:1 Walk m Other _ 7/ 13:“ Skills or Program of Interest (check if appropriate) \6
Q Filing _ Social service [3 Research I: ( 311th
[:’ Computer Trainer I: Receptionist I: Sports Recreation [3 ory
[:1 Mass Maiiiag 1:] Gardening [:1 Health/Nutrition El Cooking
E] AnimaII'Sli—elter Data Entry Photography E] Photocopyin
C] Speéial Events [:1 Typing [3 Police Explorers El Hospital Servi>e\\ /
t E Books/ Reading I: Telephoning Crime Prevention C] Theater Ar/tsx"
Craﬁs/ Sewing E Marketing - [:1 Public Relations Elena“ Ofﬁce :I Elderly cwomer (please specify) 1 ,z// Would you be interested in in teering for one timergnly’special projects? (Le. special events, mass [:1 Yes [:J\ ' i155. Previous or present volunteerjobs: pf” ‘95? Are you a member of any xplub’sfor associations? E No ‘ es (if yes, please explain) How did you hearabgtthe Union City Leisure Services Volunteer Re e I Program?
Ewan’QSchool El Radio 1:] TV [3 Newspaper E] Friends
E Other (explain) 18. Emergency Centact: rName
Address F'lLL. 0ch Hits e air/Km; I hereby certify that all statements made in this application are true, and I agree and understand that mailing, etc.) Relationship ——-—n__.._*__ Telephone W misstatements or omissions of material or facts herein may forfeit my rights to be referred to an agency or
department to volunteer.' TO BE COMPLETED BY PARENT f GUARDIAN has my permission to be a registered volunteer. Work Telephone No.
Signature of Parent / Guardian Date Home Telephone No. FOR OFFICE USE ONLY Interviewed by r gate,» Date - Log Entry ...
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This note was uploaded on 01/23/2012 for the course BIOL 101 taught by Professor Lexicon during the Spring '11 term at Ohlone.
- Spring '11