Coles and Clark, Illinois Branch Office
825 18th St.
Charleston, IL 61920
Phone: (217) 345-5166
Fax: (217) 345-5206
vkarr@il-redcross.org
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Coles and Clark Counties
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Volunteer Application
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VOLUNTEER APPLICATION

You may fill out and submit the form below or download the application in PDF format and mail it in.

General Information:
Last Name:

First Name:
Middle Initial:
Street Address:
City:
State
Zipcode:
Country:
Home Phone: - -
Work Phone: - -
Cell Phone: - -
Date of Birth: / /
Email Address:
Emergency Contact Information:
Full Name:
Phone Number:
Street Address:
City:
State
Zipcode:
Special Skills and Certifications: (Languages, Licenses, etc.)
Availability for Volunteer work: (Check all that fit your schedule and willingness to volunteer)
Days Available:
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday  
Times Available:
Days Nights Specific Times :
Have you ever worked or volunteered for the Red Cross? Yes No

If yes, which chapter, date you volunteered, and in what capacity:

References (Please list two and do not include relatives)
Reference 1
Full Name:
Street Address:
Phone Number:
Alternate Number:
Reference 2
Full Name:
Street Address:
Phone Number:
Alternate Number:
Volunteer Opportunities (Please check the activities that interest you)
Chapter Assistance:
Special Events Fund Raising
Data Entry General Office Assistance
Information/Health Fairs Blood Drives (Logan County)
 
Community Outreach:
Meals on Wheels Driver
 
Emergency Services:
Disaster Action Team (local) Fund Raising for AFES
Canteens CDL Driver
Community Dis. Ed. (CDE) National Disaster Relief
 
Health and Safety:
CPR/FA Instructors Water Safety Instructors
Pet First Aid Instructors Babysitter Instructors
Blood Pressure Clinics First Aid Stations

Participation requires a criminal and child abuse background check

Signature:
I certify that the information given herein is true and correct to the best of my knowledge
Date: / /
Interviewer's Appraisal and Comments
(Skills, knowledge, ability, aptitudes, traits or interests.
Previous Red Cross training, recognition or volunteer background.)
Interviewer:
Reviewer:
Department:
Basic Orientation Date: / /

Coles and Clark, Illinois Branch Office, 825 18th St., Charleston, IL 61920/ Phone: (217) 345-5166 / Fax: (217) 345-5206 / vkarr@il-redcross.org

Copyright ©2005-2006 The American Red Cross Illinois Capital Area Chapter. All Rights Reserved.