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First Name:
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Last Name:
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Address:
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City/State/Zip:
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Phone Number:
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Do you send/receive text messages?
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Yes
No
Email Address:
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Name of Emergency Contact:
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Relationship:
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Phone Number:
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Highest level of formal education:
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Grade School
High School
College
Graduate School
Any special Degrees, certifications, licenses or training? (example CPR)
Volunteer Preferences
Please check the area(s) at Catholic Charities of Ashtabula County you are interested in volunteering. Check all that apply
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Office/Clerical
HALO Christmas Program
Lucille's Loft
Guardianship
Other (please specify):
Other (please specify):
Availability (Please check all that apply):
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Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon
Flexible
Do you have geographic limitations within Ashtabula County?
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Yes
No
If yes, please list what areas you would like to volunteer
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Do you have access to an automobile that you would be willing to use for volunteer work?
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Yes
No
Do you have any physical limitation or are you under any course of treatment which might limit your ability to perform certain types of work?
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Yes
No
If yes, what are the limitations?
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How did you learn about the volunteer opportunities at Catholic Charities of Ashtabula County?
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Have you previously volunteered with Catholic Charities of Ashtabula County?
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Yes
No
If yes, when?
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Why are you interested in volunteering at Catholic Charities of Ashtabula County?
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I give permission for Catholic Charities of Ashtabula County to verify the information provided on this application for the purpose of obtaining information about the suitability of my being a volunteer for the organizaiton.
Signature:
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clear
Date Signed: (MM/DD/YYYY):
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