A program of:
LETTER OF APPLICATION
Date: _______________
To be completed by all persons who are not OIC employees, who wish to perform services in an OIC facility, including unpaid
volunteers, community work experience persons, community service persons, interns, and persons performing court ordered
service). Persons with disabilities who need assistance completing this application should notify HR.
Name
Other names you have used
Street Address
City, State, Zip Code
Home or Cell Phone
Work Phone
E-Mail Address
Interests Tasks and projects that you are interested in
performing (Please check selection)
Location: Garfield Elementary
___ Teaching (Instrument: _______________________)
Availability Days and hours that you are available:
___ Performing at a Fundraiser or Benefit
___a.m. to ___ a.m. Weekday mornings
___ Curriculum Design
___p.m. to ___ p.m. Weekday afternoons M T W Th F
___ Arranging / Composing Beginner Orchestra Music
___p.m. to ___ p.m. Weekday evenings
M T W Th F
___ Marketing and Social Media
___a.m. to ___ a.m. Weekend mornings
Sat
___ Program Administration / Non-profit Strategy
___p.m. to ___ p.m. Weekend afternoons Sat Sun
___ Blogging
___p.m. to ___ p.m. Weekend evenings
___ Conducting Full Ensembles
Total # of hours you wish to intern per week
___ Other: __________________________________
Reason you wish to volunteer (Please check selection)
___ Desire to help others
___ Work experience
Other: ___________________
Unlimited
In partnership with:
M T W Th F
Sun
Sat Sun
Will you need transportation to/from Yakima?
Yes
No
Comments:
___ Court Order
___ Other: ________________________________
Please circle your preference
_____ Hours
___ Family members involved in activities
___ Probation Officer Referral
OIC Administrative Offices
How were you referred?
List two references (No family members, please)
(1) Name
Relationship to Applicant
Phone
E-mail
(2) Name
Relationship to Applicant
Phone
E-mail
Special Skills or Qualifications: Summarize special skills and qualifications you have acquired from employment, previous volunteer
work, or through other activities, including hobbies or sports. Please include additional languages spoken. (Attach resume if
preferred.)
Other languages spoken: ________________________________________________________________________
Teaching and Learning: As educators and administrators working with vulnerable persons, especially working with young children,
we make a huge impact in their lives and in their learning experiences. Please share a story of when you learned something, how you
learned it, and what the impact was on you. (Can be a story of a teacher, an experience, etc.) (Attach separate sheet if preferred.)
Diversity and Teaching: As individuals, our backgrounds and experiences shape what we do, how we think, and how we teach. As
educators, we often teach others with different backgrounds, and our backgrounds may shape how we approach others. How do you
describe yourself as a person? What aspects of your background and self are most significant to you? What experiences have you had
working with people of different backgrounds (racially, ethnically, culturally, socioeconomically, etc.), and what have you learned
from those experiences? (Attach separate sheet if preferred.)
Criminal History: Notice: OIC serves vulnerable persons. To safeguard them, we perform a criminal background check for all
volunteers (including community jobs/work experience, community service, interns, etc.). Please complete attached form. A
conviction will not necessarily preclude you from volunteer service, depending on the nature of the offense. Gender and date of
birth are required by Washington State Patrol on the form, but will not be a consideration for approving you for service. Please see
Equal Opportunity statement on the bottom of this application.
Please list any criminal charges, convictions or pending legal actions, along with dates of offenses. Also state if you have been
subjected to any administrative action:
Person to Notify in Case of Emergency
Name
Address
Home Phone/ Cell Phone
Work Phone
E-Mail Address
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a
volunteer intern, any false statements, omissions, or other misrepresentations made by me on this application may result in my
immediate dismissal.
Name (printed)
Signature
Date
Parent’s or Guardian’s Approval and Signature (Required when the volunteer is less than 18 years old)
As the parent or guardian of the minor volunteering for service with OIC of Washington, I approve this service and give the Agency
permission to conduct a Washington State Criminal Background Check for this person.
Name (Printed)
Signature
Date
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, sex, color, religion, national origin, gender
identification, sexual orientation, age, veteran status, pregnancy, current or future military status, physical or mental disability,
marital or familial status or any other status protected by law.
Thank you for completing this application form and for your interest in working with us.
Applications should be received by Dec. 12, 2013 @ 5pm:
E-mail: s.hsu@yvoic.org
- or –
Postal: Stephanie Hsu
OIC of Washington
815 Fruitvale Blvd.
Yakima, WA 98902
Questions?
Contact Stephanie Hsu, YAMA Director
Tel: (509) 237-4724
E-mail: s.hsu@yvoic.org