| |
|
| Date |
|
| Name |
|
| Address |
|
| City |
|
| State |
|
| Zip |
|
| Daytime Phone (Example 999-999-9999) |
|
| Evening Phone (Example 999-999-9999) |
|
| Cell Phone (Example 999-999-9999) |
|
|
For Security Clearance |
| Date of Birth (DD/MM/YYYY) |
|
| Race |
|
| Gender |
|
| Social Security Number
(999-99-9999) |
|
| *Volunteers are required to have a valid e-mail
address. |
| Email |
|
| Employer |
|
|
Emergency Contact |
| Name |
|
| Relationship |
|
| Phone |
|
| Do you have any physical limitations (e.g., standing
or walking for extended periods) that will need to be accommodated?
If so, please state what accommodations you will need. |
|
|
| References (list two
persons, not relatives) |
| 1. Name
|
2.Name
|
| Address
|
Address
|
| Phone
|
Phone
|
| Have you ever volunteered before |
|
| If yes, for what group/organization |
|
| What are some of your strongest skills? |
|
| Availability |
| *All applicants must be available to
work all day on the day(s) selected. |
|
Friday,
April 18th |
Monday,
April 21st |
|
Saturday,
April 19th |
Tuesday,
April 22nd |
|
Sunday,
April 20th |
Wednesday,
April 23rd |
| Orientation/Interviews:
Will take place Saturday, April 5th
or Sunday, April 6th at the Robinson Center, Room 102 Which day is
best for you? |
|
Saturday,
April 5th - 1:00 p.m. - 3:00 p.m. |
|
Sunday,
April 6th - 1:00 p.m. - 3:00 p.m. |
| Training: All volunteers
are required to participate in the training sessions that will take
place Friday, April 18th, at the Statehouse Convention Center,
Conway Room. |
|
Release Statement |
| I acknowledge that I am in good physical
and mental health and I am able to volunteer for the NFBPA
conference to be held April 18-23, 2008 in the Statehouse Convention
Center, I agree to hold harmless and release the National Forum for
Black Public Administrators, Pizzazz Meeting and Event Planning,
Peabody Hotel and any persons employed or affiliated with the
aforementioned organizations from any liability due to my
participation as a volunteer for this event. I certify the
information I have provided is true and correct.
Click here if you agree to this statement. |
| |
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