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Volunteer Services Volunteer Application

Personal Details First Name * Last Name * Street Address * City * Zip code * Phone * -- Extn. Social Security Number * -- Date of Birth * JanFeb MarApr MayJun JulAug SepOct NovDec 0102 0304 0506 0708 0910 1112 1314 1516 1718 1920 2122 2324 2526 2728 2930 31 Driving License #/State * Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Educational Background School Name/Location Major Date Attended Graduate Degree Employment Information Current Employer Address Position Supervisor Phone -- Volunteer History Type of Volunteer Work Preferences I would like to volunteer on the following day(s). Monday Tuesday Wednesday Thursday Friday Saturday References Name Address Phone 1. -- 2. -- 3. -- If you have a handicap or are a disabled veteran and would like to be considered under our Affirmative Action Program, please so indicate. You need not provide us with this information if you do not wish to do so. If you choose to provide the information, it will be kept confidential with the exception informing your immediate supervisor regarding work restrictions or accommodations that may be appropriate, and first aid. Yes No If yes, describe any special adaptation needed because of the handicap: By clicking on the button "Apply", you are authorizing (BGCCC) to investigate all statements in this application.

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