<p>Our Brightest Stars</p><p>Fort Lee Volunteers</p><p>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.</p><p>1. Name______</p><p>2. Address ______</p><p>3. Birth Date (Day/Month) ______4. DEROS ______</p><p>5. Home Phone______6. Work Phone______</p><p>7. Emergency Contact Name______8. Telephone ______</p><p>9. Educational Background (Circle One) </p><p>High School 9 10 11 12 College 1 2 3 4</p><p>Other Training Courses ______</p><p>Work Experience (Paid or Volunteer) ______(add additional sheets if needed)</p><p>10. Preferred Organization (s) ______</p><p>11. How did you find out about the Installation Volunteer Program? ______</p><p>13. Goals. What would you like to gain from your volunteer experience?______</p><p>______14. Skills/Interest/Hobbies _____Foreign Language _____Recreation _____Writing _____Computers</p><p>_____Finances/Bookkeeping _____Arts & Crafts _____Clerical _____Typing</p><p>_____ Special Projects _____Public Speaking _____Other ______</p><p>15. Working Environment Preference _____No Preference _____Outdoors _____Working with staff persons</p><p>_____Working with Group _____Working with client _____General Administrative Duties</p><p>_____Other ______</p><p>Any physical restraints? ______</p><p>16. Availability. What times are you interested in volunteering?</p><p>_____Flexible _____Weekdays _____Evenings _____Weekends</p><p>17. What volunteer benefits are you most interested in?</p><p>_____On-the-job training _____Free child care _____Credit for job experience</p><p>_____Meeting new people _____Helping the community _____Possible free courses</p><p>18. Do you need help with child care in order to volunteer? _____yes _____no</p><p>(If yes, how many children and ages?) ______</p><p>Signature______Date______</p><p>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</p><p>------For Volunteer Coordinator Use Only</p><p>Agency Referral Position/Job Title Date Referred</p><p>1. ______</p><p>2. ______</p><p>Follow-up: Gratuitous Service Agreement Attached ______Referral Sent to Agency ______Record Review______Date entered into computer ______Rev Dec/02 blm Our Brightest Stars</p><p>Fort Lee Volunteers INSTALLATION VOLUNTEER PROGRAM (IVP)</p><p>Volunteer Registration & Information Process</p><p>1. Complete items 1-18 on the volunteer application form.</p><p>2. Remember to sign and date the application.</p><p>3. Please read and complete the Gratuitous Service form.</p><p>Please return the completed application packet to:</p><p>BARBARA MARTIN, INSTALLATION VOLUNTEER COORDINATOR (IVC) Army Community Service 1231 Mahone Avenue, Bldg 9023 Telephone: Civilian 804-734-7589/7083 DSN 687-7589/7083</p><p>Volunteering in Fort Lee offers flexible hours, experience you can use as employment credit and on-the-job training. Thanks for visiting! </p><p>Do you have any questions? Comments? E-mail to CW4 Amy Jones, Chapter President </p><p>E-Mail web page comments to CW5 David Dickson, Webmaster Web page updated February 5, 2012 - page created May 10, 2003 </p><p>Top of Page Crater Top </p>