NAMI McHenry County Volunteer Application
Your information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email address
*
example@example.com
Confirm email address
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Primary Phone Number Type
*
Home
Cell
Work
Secondary Phone Number
Please enter a valid phone number.
Secondary Phone Number Type
Home
Cell
Work
Have you ever been convicted of a crime?
*
No
Yes
If yes, please describe.
How did you hear about NAMI McHenry County?
*
Emergency contact
Emergency Contact Name
*
Your relationship to contact
*
Contact Primary Phone Number
*
Please enter a valid phone number.
Contact Primary Phone Number Type
*
Home
Cell
Work
Contact Secondary Phone Number
Please enter a valid phone number.
Comtact Secondary Phone Number Type
Home
Cell
Work
Education
Your highest level of education completed
*
Course of study and/or major
*
Are you familiar with Microsoft Office applications?
*
Yes
No
Skill/training/experience
Volunteer History
Have you been a volunteer with any other organization?
*
Yes
No
If yes, where:
List previous volunteer positions:
Describe any special skills, talents or interests that you think would be beneficial to your volunteer work at NAMI-MC:
Describe why you are interested in volunteering for NAMI-MC:
*
What are your days and hours of availability?
*
What type of volunteer assignment would you prefer?
*
Work History
Are you presently working?
*
Yes
No
If so, name of employer
Employer email address
example@example.com
Position
Name of previous employer
Employer email address
example@example.com
Employer phone
Please enter a valid phone number.
Position and responsibilities
Employed from
-
Month
-
Day
Year
Date
Employed to
-
Month
-
Day
Year
Date
Name of previous employer
Employer email address
example@example.com
Employer phone
Please enter a valid phone number.
Position and responsibilities
Employed from
-
Month
-
Day
Year
Date
Employed to
-
Month
-
Day
Year
Date
Name of previous employer
Employer email address
example@example.com
Employer phone
Please enter a valid phone number.
Position and responsibilities
Employed from
-
Month
-
Day
Year
Date
Employed to
-
Month
-
Day
Year
Date
Personal References
Reference name
First Name
Last Name
Reference phone
Please enter a valid phone number.
Reference email
example@example.com
Reference name
First Name
Last Name
Reference phone
Please enter a valid phone number.
Reference email
example@example.com
Reference name
First Name
Last Name
Reference phone
Please enter a valid phone number.
Reference email
example@example.com
Acknowledgement
I hereby affirm that the information provided on this application is true and complete to the best of my knowledge. I authorize a background check, reference check, and check of my driving record. I release from liability or responsibility all persons or corporations requesting or supplying information which may be sought in said investigation.I further understand and acknowledge that if I am selected to participate in the NAMI-MC Volunteer Program, I will adhere to all rules, policies and procedures of the Volunteer Program and I shall not receive any compensation for my services nor will I be considered an employee of NAMI-MC. I acknowledge and agree that I shall be providing services solely as a volunteer.Lastly, I hereby authorize the use of a photocopy of this acknowledgement by NAMI-MC in conducting the background investigation and obtaining the information I have herein authorized.
*
I agree
Signature
*
DateTime
Printed Name
*
First Name
Last Name
Submit
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