Volunteer Application (Doc)

VOLUNTEER APPLICATION UNIVERSITY OF MARYLAND EASTERN SHORE PLEASE TYPE OR PRINT Bird Hall Building – 1st Floor Office of Human Resource Management Princess Anne, md 21853 EEO/AA/ Employer

PERSONAL DATA Name (Last) (First) (Middle) (Maiden)

Present Address City State Zip Code

Phone (day) Evening# Other#

Valid Driver’s License # Exp. Date State Type/Class

In case of Emergency Contact: Phone Number (Day) Phone Number (Evening)

Health Insurance Company Policy Number Expiration Date

Allergies or Special Conditions

EXPERIENCE

Have you ever worked for the University or the State of Maryland? Yes No

In what department (s) do you wish to volunteer?

List the types of duties you would prefer to perform:

Volunteer Experience: (List current or most recent experiences first)

Company: ______Address: ______Phone # Date: Mo/Yr to Mo/Yr: ______Supervisor: Duties: ______

Company: ______Address: ______Phone # Date: Mo/Yr to Mo/Yr: ______Supervisor: Duties: ______Company: ______Address: ______Phone # Date: Mo/Yr to Mo/Yr: ______Supervisor: Duties: ______Work Experience: (List current or most recent experiences first)

Employer: Address: ______Phone # Dates: Mo/Yr to Mo/Yr Supervisor: ______Duties: ______Employer: Address: ______Phone # Dates: Mo/Yr to Mo/Yr Supervisor: ______Duties: ______Employer: Address: ______Phone # Dates: Mo/Yr to Mo/Yr Supervisor: ______Duties: ______

Briefly discuss why you want to volunteer with the University of Maryland Eastern Shore (UMES) Please indicate the highest education level completed? Less than High School High School Business/Vocational ______College Graduate

Do you possess any of the following skills? Data Entry Yes No Word Processing Equip Yes No Electronic Calculator Yes No ____ Typing Yes No List any additional skills:

Do you possess any certification to practice a Trade or Profession. If so, please indicate in the space provided below.

Are you fluent in any foreign languages? If so, please discuss.

Have you ever been convicted of a criminal offense? Yes No If yes, please give date, nature of offense and disposition

Reference: List two persons, not related to you, who have definite knowledge of your character and skills. Complete address required. I authorize contact of listed references and verification of information provided. Yes No

Name: Address: ______Phone # ______

Signature: ______Date: ______

Revised 2/9/2015