Volunteer Application

Answers to the following questions help us provide the most appropriate placement for you.
We will keep this information confidential.

* Field Required

CONTACT INFORMATION

* Mr. Ms. Mrs. Dr.
First Name *		Last Name *
Email Address *
Home Phone*	Mobile Phone	Fax Phone

Street Address *

City/State *

Zip Code *

Are you under the age of 18? * Yes No

Check if The Salvation Army may contact you via email.

EMPLOYMENT
Employer:	Division:	Title:
Does your employer participate in a Corporate Contributions for Volunteer Hours Program? Yes No
May we contact you at work? Yes No Office Number Fax Number
Street Address	City/State	Zip Code

INTERNSHIP AND REQUIRED HOURS
Do you have required hours to complete?:* Yes No - If yes, how many?:
What are the required hours for?
Internship - Level of supervision needed:		BSW MSW LAMFT OTHER
Graduation Requirement
Court Ordered	What offense was committed?
When do you need to complete your hours?		mm/dd/yyyy


VOLUNTEER AREAS OF INTEREST *
If you have no particular preference, please check this box: No Preference
Otherwise, please only select those areas in which you are genuinely interested in volunteering.
POPULATION Adults Children Teen/Youth Seniors	SERVICE AREA Addiction Character Building Disasters/Emergencies Education Food Shelf Food Service	TYPE OF POSITION Administrative Direct Contact Fundraising Holiday/Seasonal Indirect Contact
Other area if interest

AVAILABILITY
Please check all applicable times and locations you are willing and available to volunteer.
Time of Day: *	Mornings Afternoons Evenings Late Night
Time of Week: *	Weekdays Weekends
Preferred Location in Chicago:	Downtown Northside Westside Southside
Preferred Location in Suburbs:	Northwestern Western Southwestern
Preferred Counties:	Dekalb Kane Lake, IN McHenry Will Winnebago

HOW YOU LEARNED ABOUT US
Please tell us how you learned about our volunteer opportunities by selecting any of the following choices that apply.
Church/Parish Company Schools Civic Organizations United Way Food Service Other	Community Resource Network Chicago Cares Newspaper Radio Television	The Salvation Army Website The Salvation Army Donor Former/Current Volunteer Former/Current Client Former/Current Employee I am a Salvationist

FURTHER INFORMATION
Have you ever been convicted of a felony?* Yes No
Have you ever been convicted of a misdemeanor within the last 2 years which resulted in imprisonment/jail?* Yes No
If yes, please provide date(s) and details: (Note: A conviction wil not necessarily disqualify you from volunteering. Please do not disclose any information regarding criminal arrest or conviction records that have been expunged or sealed.)
Before submitting, please review Acknowledgement Agreement