<p> 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</p><p>PERSONAL DATA Name (Last) (First) (Middle) (Maiden)</p><p>Present Address City State Zip Code</p><p>Phone (day) Evening# Other#</p><p>Valid Driver’s License # Exp. Date State Type/Class</p><p>In case of Emergency Contact: Phone Number (Day) Phone Number (Evening)</p><p>Health Insurance Company Policy Number Expiration Date</p><p>Allergies or Special Conditions</p><p>EXPERIENCE</p><p>Have you ever worked for the University or the State of Maryland? Yes No </p><p>In what department (s) do you wish to volunteer?</p><p>List the types of duties you would prefer to perform:</p><p>Volunteer Experience: (List current or most recent experiences first)</p><p>Company: ______Address: ______Phone # Date: Mo/Yr to Mo/Yr: ______Supervisor: Duties: ______</p><p>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)</p><p>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: ______</p><p>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 </p><p>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: </p><p>Do you possess any certification to practice a Trade or Profession. If so, please indicate in the space provided below.</p><p>Are you fluent in any foreign languages? If so, please discuss.</p><p>Have you ever been convicted of a criminal offense? Yes No If yes, please give date, nature of offense and disposition </p><p>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 </p><p>Name: Address: ______Phone # ______</p><p>Name: Address: ______Phone # ______</p><p>Signature: ______Date: ______</p><p>Revised 2/9/2015</p>