HSAC NAACP Volunteer Application FormCommunity Service(Volunteer Position Title) Section I Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone (###) ### #### Home Phone (###) ### #### Email * Section II Area(s) of Community Service Interest (Past occupation if retired): Other information that will help us make a good match (such as education, general interests/hobbies) Section III Availability and Volunteer Assignment Preferences (Please Check All That Are Applicable): I Am Available Mornings (Mon-Fri) Afternoons (Mon-Fri) Evenings (Mon-Fri) Weekends Once A Week More Than Once A Week One Time Only As Needed OTHER Section IV Do You Have A Valid (State) Driver’s License? Yes No License Number: Vehicle License Plate Number: Insurance Company: Policy #: Have You Ever Been Convicted of a Violation of any criminal Law, Traffic or Otherwise? Yes No If Yes, Please Explain: Do You Have Any Physical Condition that May Limit Your Activities? Yes No If Yes, Describe: (Please Note: having a physical or other limitation will not disqualify you for this position) Who To Notify In Case Of An Emergency? Telephone Number Section V Please list three persons we may call who are NOT family, one of whom may be your religious or spiritual leader, teacher, employer or relationship other than personal friend. By checking the box below, I hereby give my consent to contact my references; to contact my employers, past and present; and to conduct a background check. Date MM DD YYYY Thank you! We will reach out to you as soon as possible.
