<p>Renova Community Organization Volunteer Application</p><p>Contact Information Name Street Address City ST ZIP Code Home Phone Work Phone E-Mail Address</p><p>Availability During which hours are you available for volunteer assignments?</p><p>___ Weekday mornings ___ Weekend mornings ___ Weekday afternoons ___ Weekend afternoons ___ Weekday evenings ___ Weekend evenings</p><p>Interests Tell us in which areas you are interested in volunteering</p><p>___ Administration (volunteer sign ins/outs, filing, answering phones, making calls, etc.) ___ Events (security, usher, promoter, ticket distributor, caterer, etc.) ___ Field work (home repairs, debris clean up, tarping, etc.) ___ Fundraising (security, usher, promoter, ticket distributor, caterer, etc.) ___ Delivery (donations, other volunteers, disaster victims, etc.) ___ Pick Up (donations, other volunteers, disaster victims, etc.) ___ Preppers (food, hygiene bags, as needed items for victims, etc.) ___ Equipment Operator (chainsaw, hand tools, bob cat, backhoes, forklift, etc.) ___ Volunteer Coordination (delegate duties, organization, communication, etc.) ___ Disaster Relief (all of the above)</p><p>Special Skills or Qualifications Do you have any of the following skills?</p><p>___ Chainsaw Experience ___ Commercial Driver’s License (CDL) ___ Carpentry ___ Computer Proficiency (MS Office) ___ Chaplain/Counselor ___ Sheet Rocking ___ Heavy Equipment Operator ___ Roofing (tarps) Please list: ______General Laborer ___ General Office Skills ___ Food Service ___ Other: ______</p><p>Do you have any of the following items available to bring with you?</p><p>___ Chainsaw ___ Hand Tools ___Pick Up Truck ___ Heavy Machinery (bob cat, backhoes, etc.) ___ Other: ______</p><p>Please elaborate on the skills checked above as well as summarize any other special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. </p><p>Previous Volunteer Experience Summarize your previous volunteer experience. Please include church and/or organization.</p><p>Person to Notify in Case of Emergency Name Street Address City ST ZIP Code Home Phone Work Phone E-Mail Address</p><p>Have you had any health problems, medical conditions, allergies, or other physical or mental restrictions that would affect your participation in Renova Community Organization? __Yes __ No</p><p>If Yes, please explain: ______</p><p>Is your Tetanus Immunization up to date? __Yes __ No Health Ins. Co. Name: ______Policy #: ______</p><p>Agreement and Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. I also understand that my identity will need to be verified and this application will be subjected to a background check.</p><p>Name (printed) Signature Date</p><p>Our Policy It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.</p><p>Thank you for completing this application form and for your interest in volunteering with us.</p><p>X______Volunteer Date</p>