Volunteer Application Form

Volunteer Interest Form
Upload Personal Identification Card

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Full Name

First NameLast Name
Preferred Name
Birth Date

MonthDayYear
Age
E-mail
example@example.com
Home Number
Cell Number
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Can you provide proof of eligibility to work in the United States?

YesNo
Availability

Mornings before 830aDay Shift 830a-530pEvenings after 530pWeekendsHolidaysSpecial Events
Proposed Volunteer Date

MonthDayYear
Date
Have you volunteered for The Exerscience Center in the past?

YesNo
If yes, when?

MonthDayYear
Date
Emergency Contact

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.
Education- Not Required*
Current College/University
Major/Minor
Anticipated Graduation Date

MonthDayYear
Date
Is this internship required for graduation?

YesNo
Certification & Skills:
Professional or Educational Memberships:
Current GPA:
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other College(s) info
High School - City - Dates

Background
Have you ever been convicted of a crime?

YesNo
Do you agree to a background check?

YesNo
Do you agree to a drug screening?

YesNo
Acknowledgement
I have read the internship job descriptions and I fully understand the requirements, pay if any, and employment start and end dates.Please read the following carefully before signing this application:I understand that this is an application for and not a commitment or promise of internship opportunity. I certify that I have and will provide information throughout the selection process that is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for an internship position. I certify that I am in good physical condition and can perform all outlined job functions listed in the Internship Outline. I understand that information contained on my application will be verified by The Exerscience Center. I understand that any misrepresentations or omissions may result in my being ineligible to serve as an intern with The Exerscience Center*

YesNo
Name

First NameLast Name
Signature

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Should be Empty:

Volunteer Interest Form