WLRI Volunteer Application

 WLRI INCORPORATED | Volunteer Application

Prepared for official use for operational years

2018/2019

VOLUNTEER APPLICATION | CONFIDENTIAL RECORD | NOT FOR PUBLIC VIEW

 

Contact Information |

Your Legal Name__________________________________________________________________________________________________

Street Address______________________________________________________ P.O. Box (if applicable) ______________________

City, State and Zip+4 Code _________________________________________________________, __________   ____________-______

Home Phone/ Mobile Phone _______________________________________________________________________________________

Work Phone __________________________________ E-Mail ______________________________________________________________

 

Availability | When are you available for volunteer assignments?


(add a page if more space is needed)

 

Interests in which areas you are best suited to volunteer?


 

Special skills or qualifications (attach additional pages as needed)

Skills and qualifications can be acquired through employment, previous volunteer work or other activities (such as hobbies, sports, gaming, public speaking engagements, etc.)


What additional (unrelated) skills or qualifications do you have to contribute?______________________________________________________________________________________________________________________

Previous volunteer experience:______________________________________________________________________________________

(attach additional pages as needed)

 

Person to notify in the event of a emergency: _____________________________________________Phone__________________

Relevant notes:______________________________________________________________________________________________________

 

AGREEMENT, CERTIFICATION AND ENDORSEMENT OF AUTHORIZATION

By submitting this application, I affirm that the facts set forth 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 and that all decisions by management are final.

Signature:_______________________________________________________________ Date:____________________________________

WLRI FORM 2019A

Revised 12/6/18

 

————————————————END OF APPLICATION FORM——————————————

This form was electronically generated for public use on WLRI.org or MyWLRI.com and must be printed and mailed to: WLRI Incorporated, P.O. Box 10, Bart, PA 17503-0010 for its consideration, processing and administration in any official capacity. DO NOT EMAIL, CUT AND PASTE or ALTER THIS FORM IN ANYWAY.

If you need help or would like an application mailed to you, please contact us to request one at no charge.