*Volunteer Form

*Name:

Address:
(Street, City, State and Zip)

Phone:

Cell Phone:

*Email Address:

*Are you over 18?: Yes No

Emergency Contact Person/Phone:

Education: Please select one High School College Other

Name of High School, College or University:

Occupation/Employer:

*Skills, hobbies, special training, or interests that you would like to utilize:

*Do you have sign language skills?: Please select one No Beginner Intermediate Advanced

Do you have computer or technology skills?: No Yes Word Processing Database Spreadsheet Raiser's Edge Part 200 Video Audio Video Editing Camera
Check all that apply. (Hold down the shift key to select more that one)

Area of interest at Mill Neck: Please select one Administrative Offices Library School Programs Special Events Fundraising Lunch Room Maintenance Gardening Other

Please indicate days and times you are available to volunteer:

Please list any previous volunteer or related experiences:
(Places, dates of service and positions held)

College Interns - Please list internship program requirements:
(Including hours, credit received and length of internship)

How did you hear about Mill Neck Manor?:

Why are you interested in helping at Mill Neck Manor?:

Have you ever been convicted of a felony?: No Yes

If yes, please explain:

Please state any health-related problems or restrictions:

Do you have a disability that would require accomodations?:

Resources or support would you need to do this volunteer work?:

*Agreement:
I understand that I am applying for a position as an unpaid volunteer at Mill Neck Manor and I hereby attest that the information on this form is true to the best of my knowledge. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application, or immediately discharge me from the organization’s service, whenever it is discovered. As a volunteer, I will take any problems, criticisms or suggestions to the Director of Human Resources; I will endeavor to make my work professional in its quality; uphold the traditions and high standards of Mill Neck Manor; be punctual and conscientious in the fulfillment of my duties; accept supervision graciously and conduct myself with dignity, courtesy and consideration.

*Required