Chapter Volunteer Position:
Position Title Applying For:
Personal Information:
Name:  Last	First MI
Address
City	State Zip
County	Home Phone
Mobile Phone	Fax
E-mail Address
Work/Company Name
Work Phone	Job Title
Work Address
City	State Zip
Years/Experience
Emergency Contact	Relationship
Phone	Mobile Phone
Reference 1  Name	Employer     Friend (Not a Relative)
Phone	City State
Reference 2  Name	Employer     Friend (Not a Relative)
Phone	City State
Driver's License No.	State Type
Driving Restrictions
Have You Ever Taken a Drivers Education or Defensive Driving Course? Yes     No    Date
Do You have Any Current Driving Infractions? Yes     No      How Many?  1  2   3
If Yes, Explain
Has Your License Ever Been Revoked or Suspended? Yes    No
If Yes, Explain
Do You Have Personal Transportation? Yes    No            Do You Have Vehicle Insurance? Yes   No
If Yes, are You Willing To Use Your Vehicle for Red Cross Disaster Relief Activities? Yes    No
Have You Been Convicted for a Misdemeanor or Felony Charge within the Last 24 Month? Yes    No
If Yes, Explain
Have You Ever Worked as a Paid Red Cross Employee? Yes    No     As a Red Cross Volunteer? Yes    No
If Yes, List Activities You Worked in
Previous Chapter's Name   Number of Years Worked
Address/City/ST/Zip   Phone
Education and Training:
Are You a High School Student? Yes    No        Name of School:
High School Grade Completed: 8  9  10 11 12 GED      Participate in:  Jr. ROTC    School Clubs
Are You a College or Vocational Student? Yes   No    Name of School:
College Years Completed: 1  2  3  Bachelors Masters Doctorate    Major:
Vocational/Military Training Years Completed: 1  2  3  4     Specialty:
Military Service: Army Air Force Navy MarinesReserves National Guard    Status:Active Retired
Special Skill/Hobbies/Interest:
Health Services: Doctor/Type: RN LPN CNAEMT  Other:
ScoutingHam RadioCivil Air PatrolLifeguardSwimming InstructorVolunteer FiremanPoliceman
Typing Skills:GoodAverageMinimal   WPM:  Computer Skills:GoodAverageMinimalWebmaster
Speak/Read Foreign Language (Specify): Speak OnlyRead Only Fluent
Volunteer Service Availability:
Days Available: Monday  Tuesday   Wednesday  Thursday  Friday   Saturday  Sunday
Times Available: MorningAfternoonEvening                Number of Hours Per Week You Can Volunteer:
Statistical EEOC Information (Check all that apply):
Gender: Male   Female                                        Age:                              Are You a U.S. Citizen? Yes  No
Race: Black  White  Hispanic  Asian  Pacific Islander  American Indian  Alaskan Native   Other
Disabled: Yes  No             Is it necessary to limit your physical activity in any way? Yes  No
If yes, what is your limitation?
Employed Unemployed  Retired  Homemaker                           College Student:  Full-Time  Part-Time
Veteran U.S. Military  Disable Veteran     Branch of Service:
If you are Licensed Professional, complete the following:    Profession:
License No:    State:     Expiration Date:
Background Check Consent:
To maintain the trust of the American people and provide them with the best quality service, all Red Cross employees and volunteers must be background checked. All information will be treated confidentially:
(Type in Full Name) (please check all that apply):
Yes I do, No I do not hereby give the American Red Cross, permission to inquire into my educational background, references, driving record, employment history and police records. I give permission to the holder of any such records to release the same to the American Red Cross, Jackson Area Chapter, 1981 Hollywood Drive, Suite 100, Jackson, TN 38305. If, you checked I do not, you are disqualified from working as a Red Cross employee or volunteer, proceed no further.
Yes, Upon my acceptance as a Red Cross Volunteer, I agree to go online to www.mybackgroundcheck.com/ArcVts/ and complete my required Red Cross Background Check.
Yes, I hereby hold the American Red Cross, Jackson Area Chapter, Jackson, TN harmless of any liability whether civil or criminal that may arise as a result of the release of this information about me. I further hold harmless any individual, agency, business, or corporation that provides information or documents to the Jackson Area Chapter that is responsive to a request for release of information.
Yes, I understand that the Jackson Area Chapter, will use this information as part of its verification of my application to serve as a volunteer in the American Red Cross, Jackson Area Chapter, 1981 Hollywood Drive, Suite 100, Jackson, TN 38305.
E-mail Address:   Date of Birth:
Social Security No:     Mother's Maiden Name:
Drivers License No:   State  Issue Date   Expiration Date
Post Resume (Copy and Paste):
Comments or Questions:
Please Double Check Your Entries Before Submitting The Form