St. Ann's Community - Teen Volunteer Application
Personal Information
Title:
[Select Title]
Mr.
Mrs.
Ms.
Miss
Last Name:
Required
First Name:
Required
Middle Initial:
Work Permit ID:
Required
Street Address:
Required
City :
Required
State:
[Select State]
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Required
Zip Code:
Required
Phone:
Required
Date of Birth (month/day)
It is the policy of St. Ann’s Community for teen applicants to be at least fourteen to volunteer.
In Case of Emergency Notify
Name:
Relationship:
Address:
Phone Number:
Cell Phone:
Personal Refrences
1. Name:
Relationship:
Address:
Phone #:
2. Name:
Relationship:
Address:
Phone #:
Education
School:
Required
Present Grade:
Required
Service Hours
Would this be fulfilling necessary community service hours?
yes
no
If yes, how many hours are needed?
When do these hours need to be completed?
School Organizations or other affiliations, skills, special interests:
Previous Work as a volunteer (where and when):
Employment (Present or Most Recent)
Employer:
Position Held:
Address:
City, State, Zip:
Telephone #:
Health
Physician Name, Address, & Telephone:
Are you presently under medical care?
Yes
No
If yes, please explain:
Describe any physical limitations:
Health:
Physician:
By entering your name and date below, you are verifying that all information entered above is true and accurate.
Signature:
Required
Date:
Required
Parent/Guardian's Signature:
Required
Date:
Required