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Volunteer Application
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Contact Information
Date
MM slash DD slash YYYY
Name
First
Middle Initial
Middle
Name
Last
Date of Birth
*
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Phone Number:
*
Alternate Phone Number:
Street Address:
*
City:
*
State:
*
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
*
Community where you reside (example: Sun City Grand, Sun Village, etc.)
Email:
*
Emergency Contact Information
First Name:
*
Last Name:
*
Relationship:
*
Phone:
*
Education Level
High School or GED
2 Year College
4 Year College
Masters Degree
Doctorate Degree
Community Where You Prefer to Volunteer
Sun City
Sun City West
Surprise
Peoria
Main Campus
Goodyear
Avondale
Buckeye
Tolleson
No Preference
Are you a student?
*
Yes
No
If yes, please provide the name of the school you are attending:
What hours are you available for volunteer assignments?
Weekday mornings (8:00-12:00)
Weekday afternoons (12:00-4:30)
Flexible
How did you hear about Benevilla?
Is anyone else at home address a Benevilla volunteer?
*
Yes
No
If yes, what is their name and relationship?
What type of volunteer activities/opportunities interest you?
Please list your hobbies and any special skills you have:
Do you speak any foreign languages or know sign language?
Have you ever been convicted of a crime (other than traffic violations)?
*
Yes
No
If yes, please explain.
Are you required to complete court mandated community service hours?
Yes
No
If yes, how many hours are you required to complete?
Due to the nature of our business and in accordance with state laws, our volunteers do require thorough background checks and a Level I Arizona Fingerprint Clearance Card. Do you agree to Benevilla performing background checks?
Yes
No
Do you currently have a valid fingerprint card?
Yes
No
If not, are you willing to obtain one?
Yes
No
Volunteers are also required to provide a 39-month MVD driver report for certain volunteer opportunities. (Required for any assignments in which driving is required) Has your driver’s license been revoked/suspended within the last 5 years?
Revoked
Suspended
No
I understand I will be required to provide three (3) personal or professional references (Reference letters may be emailed to bjohnson@benevilla.org or hand delivered to the main office) and I am able to obtain a Level 1 Arizona fingerprint clearance card. I am aware background checks will be completed and a 39-month certified driving history record may also need to be supplied. I am aware I must attend an orientation before I am able to volunteer with Benevilla and further understand additional training and documentation may be requested or necessary dependent upon my service placement.
*
I agree
I disagree
Agreement and Signature: I understand that my services are donated to Benevilla and are given for humanitarian reasons. I verify that the information on this application is true to the best of my knowledge. I understand that I will be required to provide at least (3) of the personal references and complete a background check and orientation before I am able to volunteer with Benevilla. I further understand that additional training and documentation may be requested or necessary dependent upon my service placement.
I Agree
I Disagree
It is the policy of this organization to provide equal opportunities to all applicants. Thank you for completing this application form and for your interest in volunteering with us. Once you have submitted your completed application, our Volunteer Services department will contact you for the next steps to becoming a Benevilla volunteer.
