Our Brightest Stars

Fort Lee Volunteers

PRIVACY ACT STATEMENT AUTHORITY: Title 10, United States Code, Section 3013. PRINCIPLE PURPOSE: To record essential background information on volunteers. ROUTINE USES: Coordinating volunteer services for U.S. Army Combined Arms Support Command and Fort Lee Installation Volunteer Program. DISCLOSURE: Providing information is voluntary. Not providing information will prevent keeping a record of individual volunteer qualifications and services.

1. Name______

2. Address ______

3. Birth Date (Day/Month) ______4. DEROS ______

5. Home Phone______6. Work Phone______

7. Emergency Contact Name______8. Telephone ______

9. Educational Background (Circle One)

High School 9 10 11 12 College 1 2 3 4

Other Training Courses ______

Work Experience (Paid or Volunteer) ______(add additional sheets if needed)

10. Preferred Organization (s) ______

11. How did you find out about the Installation Volunteer Program? ______

13. Goals. What would you like to gain from your volunteer experience?______

______14. Skills/Interest/Hobbies _____Foreign Language _____Recreation _____Writing _____Computers

_____Finances/Bookkeeping _____Arts & Crafts _____Clerical _____Typing

_____ Special Projects _____Public Speaking _____Other ______

15. Working Environment Preference _____No Preference _____Outdoors _____Working with staff persons

_____Working with Group _____Working with client _____General Administrative Duties

_____Other ______

Any physical restraints? ______

16. Availability. What times are you interested in volunteering?

_____Flexible _____Weekdays _____Evenings _____Weekends

17. What volunteer benefits are you most interested in?

_____On-the-job training _____Free child care _____Credit for job experience

_____Meeting new people _____Helping the community _____Possible free courses

18. Do you need help with child care in order to volunteer? _____yes _____no

(If yes, how many children and ages?) ______

Signature______Date______

Please return: Barbara Martin, Installation Volunteer Coordinator Army Community Services 1231 Mahone Avenue, Bldg 9023 Telephone: (804) 734-7589/7083 DSN: 687-7589/7083 Fax: (804) 734-6383 DSN: 687-6383

------For Volunteer Coordinator Use Only

Agency Referral Position/Job Title Date Referred

1. ______

2. ______

Follow-up: Gratuitous Service Agreement Attached ______Referral Sent to Agency ______Record Review______Date entered into computer ______Rev Dec/02 blm Our Brightest Stars

Fort Lee Volunteers INSTALLATION VOLUNTEER PROGRAM (IVP)

Volunteer Registration & Information Process

1. Complete items 1-18 on the volunteer application form.

2. Remember to sign and date the application.

3. Please read and complete the Gratuitous Service form.

Please return the completed application packet to:

BARBARA MARTIN, INSTALLATION VOLUNTEER COORDINATOR (IVC) Army Community Service 1231 Mahone Avenue, Bldg 9023 Telephone: Civilian 804-734-7589/7083 DSN 687-7589/7083

Volunteering in Fort Lee offers flexible hours, experience you can use as employment credit and on-the-job training. Thanks for visiting!

Do you have any questions? Comments? E-mail to CW4 Amy Jones, Chapter President

E-Mail web page comments to CW5 David Dickson, Webmaster Web page updated February 5, 2012 - page created May 10, 2003

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