Thank you for joining our ministry of service! You make it possible for us to serve the most vulnerable in our communities. Please fill out the following form and we will contact you soon about a possible volunteer placement. Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Daytime PhoneIn case of emergency, please contactList name, phone number and relationshipSkills and InterestsIf you already know where or in what job you would like to volunteer, please list it:Please check any of the populations with whom you are interested in working: Children and families People with disabilities Seniors Veterans Other What times/days are you available to volunteer? Anytime Weekdays Weekends Evenings How often would you like to volunteer? Weekly Monthly Occasionally Other If you have a geographic preference for volunteering, please list area/neighborhoodDo you have access to transportation to get to/from your volunteer work?YesNoBackground InformationGenderMaleFemalePlease specify your raceWhiteAfrican AmericanAsian/Pacific IslanderHispanic or LatinoNative AmericanDate of BirthWhat is your educational background (high school, some college, degrees earned, etc.)?What is your current occupation?Are you serving or have you ever served in the U.S. Military?yesnoHave you been convicted of a criminal offense?YesNoIf you have a disability, please list any accommodations you need to volunteer:How did you hear about Volunteers of America Current volunteer or staff member News story Our Website Another nonprofit organization TV ads Waivers/AgreementsPlease check the agree box after each of the following sections.Liability Release: I wish to volunteer. I may perform in a capacity as a volunteer that may involve physical activity, contact with unidentified and/or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this and in consideration of being allowed to volunteer, I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY PERSONAL INJURY AND/OR PROPERTY DAMAGE THAT I SUSTAIN OR CAUSED DURING MY PARTICIPATION AS A VOLUNTEER. IN ADDITION, I HEREBY RELEASE, HOLD HARMLESS AND CONVENANT NOT TO FILE SUIT AGAINST ANY GROUP AFFILIATED WITH THIS VOLUNTEER OPPORTUNITY.*AgreeDisagreePolicies and Procedures: I have read and understand the volunteer policies and procedures that are listed online at www.voanorthla.org under the volunteer tab. I understand that failure to adhere to these policies may result in termination of my volunteer placement with Volunteers of America of North Louisiana*AgreeDisagreeMandatory reporting: I understand that under Children's Code Article 609(A) I will be considered a "mandatory reporter," and will be obligated to report any abuse or neglect of a child or other client of Volunteers of America.*AgreeDisagreePhoto Release: As a volunteer I hereby give my consent for representatives of this event, news media and others affiliated, to photograph me while volunteering. I also give my permission for the use of said photographs in literature, websites and other promotional materials.*AgreeDisagreeVolunteer agreementI verify that the above information is true. I understand that any false or misleading information is ground for denying or terminating my volunteer placement. I further understand that copies of this application will be sent to the Volunteers of America program in which I have indicated interest. The original will be retained in my volunteer personnel file.SignatureCommentsThis field is for validation purposes and should be left unchanged.