Please type, or print legibly …

Full Name _____________________________________ Age _____ Telephone ________________

Full Mailing Address _________________________________________________________________

_________________________________________________________________

E-Mail Address _________________________________ U.S. Citizen? (yes or no) _________

What volunteer position(s) are you applying for?:

Availability (When would you be available for volunteer service, starting and ending dates? and how many hours per week?):

Do you require lodging? (Please refer to the volunteer position description to see if lodging is available):

Please give details of your experience relating to the volunteer positions you are applying for (attach a resume, or write a narrative description on the reverse of this sheet):

References (Please provide the information needed to contact two persons familiar with your abilities, knowledge, and experience.):

Name: Telephone: E-mail:

Name: Telephone: E-mail:

Notice to the Volunteer: Volunteers are not considered to be Federal employees for any purpose other than tort claims and injury compensation. Volunteer service is not creditable for leave accrual or any other benefit. However, volunteer service is creditable work experience.

Signature (Please sign in ink.) ______________________________________ Date ________________

JODA – 3/04