Current Date Thursday, May 17, 2012 5:50 pm
Date of Birth*
Last Name*
First Name*
Middle Initial
Maiden/Prior
Home Address*
Apt./Building #
City*
State*
ZIP*
Mailing Address (if different than Home Address)
Apt./Building # (mailing)
City (mailing)
State (mailing)
ZIP (mailing)
Primary phone # *
Business phone #
Fax #
E-mail address*
Employer
Occupation
Employer address
Emergency contact information
Please list two people whom we could contact in the event of an emergency.
Emergency contact #1 *
Emergency contact #1 phone
Emergency contact #1 address*
Emergency contact #2
Emergency contact #2 phone
Emergency contact #2 address
Experience, skills and education
Please relate any professional/personal experiences, skills, education and/or applicable licenses that you feel would help make you a successful Red Cross volunteer.
Experience
Current professional license, if any:
Additional professional license, if any:
Name(s) of most recently attended educational institution(s) (students, indicate current school)*
Institution City/State
Date attended/anticipated graduation date
Degree/major
Fluent language skills (include sign language)
Other skills (computer, filing, teaching, etc.)
Upload your resume/CV (optional)
Volunteer opportunities
Please check all that interest you.
Other (please specify)
Please indicate your availability (times and dates)
Have you ever worked as a Red Cross employee?
If yes, give position, dates and location:
Have you ever served as a Red Cross volunteer?
If yes, give position, dates and location:
Have you ever held any Red Cross certification?
If yes, please list:
Background information
Substance Abuse Policy: The American Red Cross strictly prohibits the use of alcohol and illegal substances from being on, or used on, Central Illinois Chapter property or time. Volunteers are also prohibited from reporting for volunteer assignments under the influence of drugs or alcohol and may be subject to drug testing at the discretion of the Chapter. A violation of this policy will result in termination of the volunteer's service. Creating a safe work environment is a top priority of the Central Illinois Chapter. The substance abuse policy demonstrates our commitment to our volunteers and our belief that drug or alcohol poses a serious risk not only to the individual, but to other volunteers and the Central Illinois Chapter's future as well. In addition to emphasizing the Chapter's belief that safety is essential, the policy underscores the Red Cross' commitment to a drug-free environment.
Criminal Background Check Policy: The American Red Cross will conduct reference checks and a criminal background check. If I refuse to have a background check, this application is void. Volunteers also agree to sign an Intellectual Property Agreement and a Code of Conduct.
Harassment Policy: It is the policy of the Central Illinois Chapter that all individuals are treated with dignity and respect. Harassment, whether based upon race, color, sex, religion, national origin, age, or any other personal characteristics, is a form of misconduct that undermines the integrity of the volunteer relationship. It is behavior that is unwelcome and personally offensive. It debilitates morale and consequently interferes with work effectiveness. Accordingly, harassment in any form will not be tolerated and those found to have engaged in harassment will be disciplined as appropriate, which may lead to and include termination as a volunteer.
I have read and understand the above policies and agree to abide by them.
Answers to the following questions do not necessarily disqualify an applicant.
Are you licensed to operate a vehicle in Illinois?
Driver's license number
If your license has ever been revoked, please explain
Have you ever been bonded?
Has your bonding ever been revoked? If yes, please explain
Have you ever been convicted of a crime, in Illinois or any other state?
If yes, please explain:
Have any of your certifications ever been revoked? Please explain:
Personal references
Please list two people whom we could contact for a reference.
Name of reference #1 *
Reference #1 address
Reference #1 phone*
Reference #1 e-mail address
Name of reference #2
Reference #2 address
Reference #2 phone
Reference #2 e-mail address
IMPORTANT - Consent
I do hereby give the American Red Cross permission to inquire into my educational background, references, driving record, police records, employment and/or voluntary history. I further give permission to the holder of any such records to release the same to the American Red Cross. I do hereby hold the American Red Cross harmless from 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 above-named American Red Cross unit. I understand that the American Red Cross will use this information as part of its verification of my volunteer application and periodically for evaluation purposes.
Type your full name here to indicate consent*
OPTIONAL - Statistical information
The American Red Cross, in recognition of its responsibility to employees, volunteers and the community it serves, reaffirms its policy to assure fair and equal treatment in all of its practices, for all persons. The American Red Cross will not discriminate on the basis of race, color, religion, sex or national origin, or against any qualified handicapped individual, disabled veteran or veteran of the Vietnam era. The following information is requested solely to determine the diversity of Red Cross volunteers.
While completion is optional, it would be most helpful to us as we monitor the complete record of our program.
Gender Male Female -----------
Are you a veteran? Yes No -----------
Are you disabled? Yes No -----------
Union affiliations, if any:
Ethnic group (choose one) Black White Hispanic Native Hawaiian/Pacific Islander Asian American Indian/Alaska Native Other -----------
If other, please describe:
IMPORTANT - Click the blue "Submit" button below to proceed with your application.
You will be directed to the next step, where you will have an opportunity to review your answers and change any, if desired. Once you review your form, you will be asked to type alphanumeric characters into a text field, and then click "Submit Form." You MUST click the blue "Submit Form" button for your application to be processed.
*Asterisk denotes required field