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Volunteer Service Application

  1. APPLICANT INFORMATION

  2. Days Available*

  3. EDUCATION

  4. VOLUNTEER EXPERIENCE

  5. Have you ever volunteered before for Kent City Health Department?

  6. MOST RECENT EMPLOYER

  7. May We Contact Them?*

  8. PROFESSIONAL REFERENCES

    (Minimum of Two)

  9. EMERGENCY CONTACT PERSON IN CASE OF EMERGENCY

  10. Have you ever been convicted or plead guilty in court (even if you did not have a trial) of anything other than a misdemeanor or minor traffic violation?*

  11. AUTHORIZATION

  12. Your electronic signature indicates that the facts contained in this application are true and complete to the best of your knowledge. False statements on this application shall be grounds for dismissal from the volunteer program. You authorize approval to check references. The organization is not obligated to provide a volunteer placement, nor are you obligated to accept it. Your electronic signature also indicates that you are volunteering for humanitarian purposes to benefit the public good and without compensation.

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