CHOICES Volunteer Application
Basic Information
Name:
Date:
Phone Number:
Address:
(Street Address)
(City)
Email Address:
References
1. Name:
Relationship:
Phone Number:
2. Name:
Relationship:
Phone Number:
3.
Name:
Relationship:
Phone Number:
(State)
(Zip)
Employment History
1. Company:
Job Title:
Start Date:
End Date:
Briefly Describe Job Duties:
2. Company:
Job Title:
Start Date:
End Date:
Briefly Describe Job Duties:
Employment History (Continued)
3. Company:
Job Title:
Start Date:
End Date:
Briefly Describe Job Duties:
Volunteer History
1.Company:
Start Date:
End Date:
Briefly Describe Volunteer Duties:
Was this experience rewarding?
Yes
No
Yes
No
Briefly describe why you feel this way:
2.Company:
Start Date:
End Date:
Briefly Describe Volunteer Duties:
Was this experience rewarding?
Briefly describe why you feel this way:
Volunteer History (Continued)
3.Company:
Start Date:
End Date:
Briefly Describe Volunteer Duties:
Yes
Was this experience rewarding?
No
Briefly describe why you feel this way:
Volunteering with CHOICES
Please check one Volunteer Position that best matches your interests and skills:
 Shelter services assistant
 Child care worker
 Displays/Speakers bureau
How long are you able to commit to volunteering with CHOICES?
How many hours a week are you able to volunteer with CHOICES?
Please provide information on your availability:
Monday
 Daytime
 Evening
 Not available
Tuesday
 Daytime
 Evening
 Not available
Wednesday
 Daytime
 Evening
 Not available
Thursday
 Daytime
 Evening
 Not available
Friday
 Daytime
 Evening
 Not available
Saturday
 Daytime
 Evening
 Not available
Sunday
 Daytime
 Evening
 Not available
Please provide a one (1) page essay on why you want to volunteer with CHOICES and how your
previous experiences have prepared you to work with CHOICES.
You can submit your application by email or by mail. Applications may be handwritten or typed. Please
sign your application prior to submission.
Email applications to:
svillilo@lssco.org
Mail applications to:
Sue Villilo
500 W. Wilson Bridge Rd.
Suite. 245
Worthington, OH 43085
My signature indicates I am 18 years of ages or older and I have completed a BCI&I background
check and a TB Test. I also give permission to contact references.
Signature
Date