JLSCC Volunteer Application Volunteer ApplicationDate *First Name *Last Name *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryHome Phone *Work Phone *Email *Emergency Contact Name *Emergency Contact Relationship *Emergency Contact Phone *Where did you learn about our volunteer opportunities? *If you speak any other languages other than English please list here: Do you have any experience working with children or volunteering? If so, where? *What is your current occupation? *May we contact your current place of employment for a reference? If yes, please list your supervisors name and phone number. *Select your position of interest: *Helping children read or reading to themAssisting with fundraisingMentoring teensHelping children use computersAssisting in the game roomChaperoning a field tripAssisting the Administrative Office & Clerical workActivities not listed that I am interested in: HAVE YOU EVER BEEN CONVICTED OF A CRIME OTHER THAN MINOR TRAFFIC OFFENSES? *If yes, explain number of conviction(s) leading to conviction(s) how recently such offense occur, was/were committed, sentence(s) rendered and types of rehabilitations:HAVE YOU EVER BEEN TERMINATED FROM EMPLOYMENT FOR ANY REASON? *If yes, please explain the reason why.Please upload your resumé below. * I certify that the information contained in this application is accurate and correct. I understand that any omission or erroneous information may be grounds for dismissal. I authorize the references listed above to give you any and all information concerning my previous volunteer assignments pertinent to you. I also understand that volunteer assignments are subject to a background check. These policies do not create any promises or contractual obligations which mean either party may separate from said volunteer assignment with or without cause.Date *Signature * VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
