Online Volunteer Form

Please fill out this form entirely. Everything listed here is required!

1. Personal Information
Name:

Date:

Address:

City:

Zip Code:

Home Phone:

Work Phone:

Email:

Date of Birth:

Place of Birth:

Ethnicity:

Social Security Number:

Driver's License Number:

How did you hear about Brazos Bend Guardianship Services?

Are you fluent in any foreign languages? Please list them

2. Education
Highest Level of Education Completed (required)

Area of Study (required)

3. Employment History

Please provide your employment history in the text area below. Please include the employer, their telephone number, your position, your supervisor, how long you worked at your current position, your weekly work hours, and a brief job description for each job:

4. Volunteer Related Information

How much time can you contribute to volunteering?
2-4 hours/Month4-6 hours/Month6-10 hours/month10+ hours/month

When are you available?
WeekdaysWeekends

What times are you available?

What type of volunteer position(s) are you interested in (please check all that apply)
Money ManagementGuardian AngelAdministrative

What are your interests/hobbies? (Please seperate multiple hobbies/interests with a comma)

5. Previous Volunteer Experience

Please list your previous and/or current volunteer experiences (please include the name of the organization along with any duties performed each separated by a page break):

6. Special Skills/Qualifications

Please list any special skills/qualifications below. (Separate each with a comma)

7. Criminal History Information

Do you use illegal drugs?
YesNo

Has your driver’s license ever been suspended or revoked in any state?
YesNo

Have you ever been arrested, charged or convicted of a crime other than a traffic violation?
YesNo

Have you ever been a plaintiff or defendant in a civil lawsuit other than a divorce?
YesNo

If answered yes to any of the above, please provide a brief
explanation:

8. References

Please list any references in the text area below, each separated by a page break. (Please list spouse if married. If not married, list only one family member.
The other 3 names should be individuals that have known you at least 3 years and not related to you
in any way. No former employers)

EMERGENCY CONTACT: Please include: Name, Address, Phone # & Relationship

I hereby affirm that my answers to the foregoing questions are true and correct and that I have not
knowingly withheld any fact or circumstance that would, if disclosed, affect my application
unfavorably. I understand that any false information submitted in this application may result in
my discharge.

Please Sign Below:

Please Sign the Date Below:

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