Volunteer Application Personal InformationName* First Middle Last Gender*MaleFemaleAddress* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home/Cell Phone*Work PhoneEmail Address* Are you 18 years of age or older?*YesNoWhat is your birth date?* AvailabilityHow often are you interested in volunteering:* 2-3 times / week Weekly Monthly Other Please mark the times you are available to volunteer belowMonday Morning Afternoon Evening Tuesday Morning Afternoon Evening Wednesday Morning Afternoon Evening Thursday Morning Afternoon Evening Friday Morning Afternoon Evening Saturday Morning Afternoon Evening Sunday Morning Afternoon Evening InterestsWhat volunteer position(s) are you interested in? Visiting Residents Help with Bingo Gardening Sewing Animals/pet therapy Beauty shop assistant Parties, Special Events Special presentation for residents Reading to Residents Bible Study/religious Services Music (Singing, Play instrument Gift Shop Cooking Arts & Crafts Play cards or games (Check all that apply)OthersWhy Are You Applying to Volunteer?Please indicate why you want to volunteer at ICMCF and what you hope to gain.EducationAre you currently in School?*YesNoPlease indicate school name*Highest level of education completed?*High SchoolCollegePost GraduateEmployment HistoryAre you currently Employed?*YesNoPlease list your most recent employer:Company*Address Street Address City State / Province / Region ZIP / Postal Code PhoneEmail PositionSupervisorHave you ever volunteered or been employed by ICMCF?*YesNoPlease indicate position*Date* ReferencesPlease list two references other than relatives or employers:Full Name*Phone Number*Relationship*Years Known*Full Name*Phone Number*Relationship*Years Known*BackgroundDo you have any felony charges pending against you?*YesNoHave you ever been convicted or pled guilty or no contest to a crime?*YesNoPlease explain by giving date, nature of the offense, and circumstances below*Conviction of a crime will not necessarily disqualify an applicant from volunteering.AcknowledgementAre you able to perform the essential volunteer job duties of the volunteer positions for which you are applying with or without reasonable accommodation?*YesNoOn entering the captcha and clicking submit button, I will volunteer according to my schedule, be dependable, honor the right's of residents and follow all ICMCF policies and guidelines. I give permission for my employment, school and other associates to be contacted for a reference. I also understand that ICMCF will conduct a criminal background check prior to extending any offer for volunteer position.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.