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SAN DIEGO ARMED SERVICES YMCA

APPLICATION FOR VOLUNTEER SERVICES
Date____________
This association does not discriminate in securing volunteers on the basis of race, color, religious creed, national origin, sex, or ancestry; or
on the basis of age against persons whole age is over 40 or on the basis of handicap or disability and any other characteristic required by
law. No question on this form is intended to secure information to be used for such discrimination.

1. Name (in full) _______________________________________________________________________________________

Last First Middle
sdf s s
2. Residence __________________________________________________________________________________________
Street Address City State Zip

3. Telephone Numbers s
Home __________________________________ Cell sdfsg
________________________________

4. Email Address __________________________________________ 5. Date of Birth: __________ Military: Y N

6. How did you hear about our volunteer program? ____________________________________________________________

7. Why are you interested in volunteering for the San Diego Armed Services YMCA?
_____________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

8. Please prioritize your top 1, 2, and 3 reasons for wishing to become a volunteer, with #1 being most important:
Socialization Community Involvement School Requirement Retired
Networking Career Exploration Helping Others Other

9. Please check the type of volunteer work you are interested in:
Pediatrics Patient Greeters Liberty Center Neighborhood Exchange
Patient Recreation Ward Visitors Event Participation Youth & Community
Ward Leaders Therapy Dog Escort Transportation ASYMCA Office

10. Describe previous volunteer experience:

_____________________________________________________________________________________________________

11. Length of time you are willing to commit to volunteering: less than 6 months 6 months to 1 year 1 year +

12. Do you have any physical restrictions that require accommodation? ___________________________________________

13. Are you certified in any of the following? First Aid CPR Pediatric CPR Lifeguard

14. Have you ever been convicted or any criminal offense other than the following: minor traffic violations fine $500.00 of
less; or offenses settled in juvenile court or under welfare youth offender law? Yes No
If yes, please explain. __________________________________________________________________________________

15. REFERENCES (exclude relatives)

For reference-checking purposes, indicate other names under which you have worked/volunteered:

a) __________________________________________________________________________________________________
Name Occupation Cell Phone Work Phone
b) __________________________________________________________________________________________________
Name Occupation Cell Phone Work Phone

16. Do you have a valid driver’s license in this state? Yes No # _____________________________
17. Do you have a valid Class 11/B license in this state? Yes No #______________________________
18. Do you possess a youth bus/school bus driver’s certificate? Yes No
19. Are you over 21? Yes No
IN COMPLIANCE WITH U.S. DEPARTMENT OF TRANSPORTATION FHWA, THE ASYMCA WILL CONDUCT PRE-AGREEMENT DRUG TESTING AND RANDOM
DRUG AND ALCOHOL TESTING OF BUS DRIVERS

PLEASE EMAIL COMPETED APPLICATION TO ERIN LESTER AT: ERIN.LESTER@MED.NAVY.MIL