• Printable Volunteer Application
Volunteer Information and Health History Form
General Information

Gender
EDUCATION
PHOTO RELEASE
I hereby DO or DO NOT

Consent to and authorize the use and reproduction by The Charles Lea Center, Inc. of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, exhibitions, or for any other use for the benefit of the program.

Are you retired


VOLUNTEER EXPERIENCE AND TRAINING

(If you have volunteered at another organization)




REFERENCES

(Please provide complete addresses for all references listed)




BACKGROUND INFORMATION

(Please answer the questions below as completely as possible.)

Do you have any physcial disabilities that may affect or limit your work
Are you on any medication(s) and/or under medical supervision
Have you ever been convicted of a felony
GENERAL QUESTIONS
CERTIFICATION OF APPLICANT

By submitting this form, you certify that your answers on this application are true and complete to the best of your knowledge. You also grant your permission and consent for us to contact the necessary resources and references to verify your responses on this application.