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PERSONAL INFORMATION

Animal Control Volunteer Application
Full Legal Name:*
Preferred Name:*
Street Address, City, State, Zip*
Full Mailing Address (if different from above)
Phone:*
E-Mail Address:*
Emergency Contact Name:*
Relationship to you:*
Contact Phone Number*
How did you hear about us?*
SKILLS AND INTERESTS
Education Background:*
Current Occupation*
List Hobbies, Skills and Interests:*
Have you had any formal education in animal care or animal welfare?*
1. Yes
2. No
Please list formal education in animal care or animal welfare:
Volunteer Goal (reason). Please check all that apply:*
1. Contribution to Community
2. Corporate Sponsorship
3. Court Ordered
4. Internship
5. Outreach
1. Resume Enhancement
2. School Credit
3. Seasonal
4. Socialization
5. Other
List "Other" reason for wanting to volunteer:
*PLEASE NOTE*
ALL COURT ORDERED/COMMUNITY DIVERSION SERVICES REQUIRED TO PROVIDE DOCUMENTATION FROM THE COURT REFERRAL SOURCE
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Our Volunteer program will require screening with a Criminal Records check. Do you consent to the performance of this screening prior to placement? Your refusal to do so may exclude you from consideration for some or all types of volunteer activities with our organization.*
1. Yes
1. No
Date of Birth:
Date of Birth:
Drivers License Number
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PLEASE READ CAREFULLY *
By checking the "I agree" box below, you are confirming that you have never been convicted of animal cruelty, neglect or abandonment in this state or any other.
By providing your electronic signature, you agree and acknowledge that this signature is valid and binding and has the same force and effect as your handwritten signature,
1. I agree.
Electronic Signature (Please use entire legal name)*

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