The Job Foundation

    Information

    Last Name
    First Name
    M.I.

    Address
    Apt/Unit #

    City
    State
    ZIP Code

    Phone
    Email

    Date Available
    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