Support Group Facilitator Volunteer Application

Background Information













Education, Professional Licensure/Certifications and Trainings






Other Education






Employment Information








Special Skills and Volunteer Interest






Please indicate your days and hours for availability to volunteer:
Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Policy Acknowledgment and Acceptance

It is the policy of this company to provide equal volunteer opportunities to all qualified persons without regard to race, religion, creed, color, national origin, gender, marital status, veteran status, sexual orientation, disability, age, genetic information or any other factor protected by applicable federal, state and local laws as was as other application government regulations and execution orders. 

I understand that this is an application for and not commitment or promise of volunteer opportunity. 

I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge, and I authorize the investigation of all statements contained within this volunteer application that may be necessary in arriving at a decision for a volunteer position. I understand that misrepresentation or omission may be cause for my immediate rejection as an applicant for a volunteer position with the Alzheimer’s Association or my termination as a volunteer.  


References
Please list the names, addresses and phone number of three people you would like to use as character references. Include at least one relative, and make sure the other two are people you’ve known for at least one year.

Reference #1









Reference #2









Reference #3