VOLUNTEER APPLICATION FORM

     SOSAECHAITI VOLUNTEERS NETWORK

Help Children and Communities in Haiti

 

Volunteer Application Form 

Name:_____________________________________      Male                 Female

Home phone:_______________Cellphone:_____________BirthDate:__________

Address:________________________________________________________

City:___________State:__________Zip:________E.mail:_________________

Company/School:_____________________________Grade level:____________

Emergency Contact

Name:____________________________________Relationship:___________

Home Phone:______________________________CellPhone:______________

Availability (Check all that apply)

 Weekdays AM Shift               Weekdays PM Shift       Weekend AM Shift

Weekend PM Shift

Type of Volunteer

 Exhibit/Programs Volunteer            Family Volunteering      Special Events

 Materials Prep              Corporate group Projects                 Other Group Projects

What would you like to learn from your volunteer experience?_________________________________________________________

List your special hobbies, skills and talents:____________________________

What languages do you speak fluently?________________________________

Volunteer work experience_________________________________________

How did you hear about us?________________________________________

Have you ever been convicted of a crime?__________if yes, please explain:_________________________________________________________

I certify that all information submitted by me on this application is true and complete. I understand that if any false information, omissions, misrepresentations, are discovered, my application maybe rejected and active volunteer status maybe terminated at any time. In consideration of my volunteer application, I agree to adhere to the policies and regulations of SOSAEC HAITI.

Signature:_______________________________________________________

                                                                   Volunteer Application Form

References:

Name:___________________________________ Phone:____________________

Name:___________________________________ Phone:____________________

Name:___________________________________ Phone:____________________

Parent’s signature is required for volunteers under 18 years of age

Signature:________________________________Date:______________________

Parent’s Printed name:________________________________________________

SOSAEC HAITI

208 Ruelle Usine A Glace Toto, Carrefour-Paloma

Port-au-Prince, Haiti W.I

E.mail : sosaec.haiti@yahoo.com

Phone Number : 509 37 63 02 80