Volunteer Information

VOLUNTEER APPLICATION

* Required Fields

Contact Information
* First Name
* Last Name
* Address
Address 2
* City
* State/Province
* Zip/Postal Code
Home Phone
* Cell Phone
Work Phone
* Email

About You

The following information is for statistical purposes only. The Carter Burden Network does not make decisions regarding volunteer assignments on the basis of age, race, gender, sexual orientation, ethnicity or any other legally protected class.

Gender

* Age Range

Date of Birth

Employer

Position

Volunteer Opportunities
The Carter Burden Network offers a range of volunteer programs for individuals and groups, including a one-time service day or a long-term commitment. Please indicate your order of preference.
* Preference 1
Preference 2
Preference 3
If there are other ways you'd like to volunteer, please describe
If you selected "Class Instructor", what kind of class are you interested in teaching?

Volunteer Information
How did you hear about us?		* Why do you want to volunteer?
Do you have any volunteer experience? If yes, please explain
Tell us about any hobbies or interests you have that might be relevant to the program you have applied for (ex: Friendly Visiting)
* Do you speak a foreign language?		If yes, please specify
Do you have any physical needs that require special arrangements?		If yes, please explain
Please specify the days and hours available
Monday		Hours
Tuesday		Hours
Wednesday		Hours
Thursday		Hours
Friday		Hours
Saturday		Hours
Sunday		Hours

For Students Only
How many service hours do you need to complete?
Name of School
Year in School		Major
What is your counselor's name and contact information?

Emergency Contact
* Emergency Contact Name		* Relationship
* Phone

References
Please mention below two references that we will contact shortly in order to complete your volunteer application. Please note that we will contact your references in priority by email.
* Reference Name 1		* Relationship
* Phone		* Email
* Reference Name 2		* Relationship
* Phone		* Email

Volunteer Agreement
* I understand that all volunteers are required to submit a copy of their photo ID to [email protected] prior to volunteering with a Carter Burden Network program.
* I hereby swear and attest that all information provided on this volunteer application is true and complete to the fullest extent of my knowledge. The Carter Burden Network may contact my references and may conduct a background check. The Carter Burden Network reserves the right to reject a candidate for any reason that the agency, in its sole judgment, determines will or may affect either the best interests of a senior or the organization. Furthermore, the Carter Burden Network reserves the right to withhold the reason(s) for such a refusal.
* I hereby grant to the Carter Burden Network the irrevocable and unrestricted right to use and publish all photographs and video/audio/electronic recordings of me, or in which I may be included, for publications, electronic reproductions (websites, social media), and/or promotional materials or any other purpose and in any manner or medium. I hereby release the Carter Burden Network from all claims and liability relating to said photographs. I understand and agree that this paragraph also applies to my minor child/children who is/are volunteering.
* I agree that in the course of my participation in the volunteer projects, I may have access to personal information of other persons. I agree to maintain the confidentiality of such information, to use such information only as necessary to do my job as a volunteer, and to comply with the Carter Burden Network for applicable policies regarding such information.
* As a volunteer for the Carter Burden Network, I understand my obligation to fulfill my volunteer responsibilities and duties to the best of my ability. We ask that you notify us as soon as possible if you are unable to volunteer. I understand I will be required to log my volunteer hours as explained to me by Volunteer Services.		* Please type your full name acknowledging information provided above.

We keep your personal information private and secure. When you submit this form, your name, contact information, and any additional information will be available only to our organization.