The Job Foundation
Information

Last Name
First Name
M.I.

Address
Apt/Unit #

City
State
ZIP Code

Phone
Email

Date Available
Social Security No
Date of Birth

I am interested in helping with

Have you lived outside of Iowa in the past seven years?

If so, please list all other states you have lived in the past seven years

Are you on the Sex-Offender Registry?

Do you have a valid driver's license?

Have you ever been convicted of a crime, pled guilty, or been given a deferred judgment?

If yes, please explain

Are you interested in short-term or long-term volunteering opportunities?

Have you applied to other mentoring organizations?

If you have mentored elsewhere, where?

Are you or have you been a Foster Parent? Have you ever applied? If so, please give a DHS reference contact.

Education/Interest

High School
Address

From
To

Did you graduate?

Diploma


College
Address

From
To

Did you graduate?

Degree


I am interested in volunteering in the following areas:

Mentoring tutor - Meet 1:1 with student 4 hours/month commitment. Min 18 mos.

Marketing, technology, or interpreting volunteer

Finance, fundraising, or education committee

Occasional volunteer - helps with large group events as schedule allows

Other, please describe

References

Please list three personal references.

Full Name
Relationship/Yrs Known

Company
Phone

Address


Full Name
Relationship/Yrs Known

Company
Phone

Address


Full Name
Relationship/Yrs Known

Company
Phone

Address

Previous Volunteerism References

Place of Activity
Phone

Address
Supervisor

Job Title/Responsibilities

From
To
Reason for Leaving

May we contact your previous place(s) of volunteerism for a reference check?


Place of Activity
Phone

Address
Supervisor

Job Title/Responsibilities

From
To
Reason for Leaving

May we contact your previous place(s) of volunteerism for a reference check?

Disclaimer and Signature

In case you are with us or at the school volunteering and have an emergency, whom should we contact?

Name of Emergency Contact
Phone Number