The FOOD BANK OF MONMOUTH AND OCEAN COUNTIES

Volunteer Information Form

Date of Application: ________________________

We would appreciate you filling in and returning this to our office.  We will contact you to arrange an interview.

PERSONAL INFORMATION  (please print)

Mr. o  Mrs. o  Miss o

Last Name: ___________________________  First: _____________________  MI: _____                                                              

Nickname: _____________________________ Spouse: ________________________________

Street: ___________________________ City:  ________________ State: ____ Zip: _________

Home Phone: __________________________  E-mail Address: ___________________________

Birth Date: _______________  (Month/day)

Group Name: _________________________________________ Phone: ___________________

Address: _______________________________________________________________________

Have you ever committed, been convicted of, pled guilty to or pled nolo contendo to a felony

or a misdemeanor?  (Note:  Conviction of a crime is not necessarily grounds for disqualification)   Yes: _____________  No: _______________

If yes, please explain ___________________________________________________________

Please give us the name, address and telephone number of someone who can be notified in case of emergency

Name: ___________________________ Address: _______________________________________

Relationship: ________________________________________

Home Phone: ______________________________ Business Phone: _______________________

VOLUNTEER EXPERIENCE

Have you ever volunteered before?  Yes _______ No ________   If yes, please list the last two  organization(s)

___________________________________________________  From:_________ To: _________

Name/Address/Phone

___________________________________________________  From:_________ To: _________

Name/Address/Phone

How were you referred to the FoodBank to volunteer?

__________________________________________________________________________

BACKGROUND

  o Currently Employed         o Currently Unemployed              o Retired

Employer: ________________________________________ Work Phone: _________________

Occupation: ______________________________________________________________________

Education: _______________________________________________________________________

COMMITMENT

 Volunteer work preferred:

 o Warehouse     o Sort Room     o Community Garden     o Special Events 

 o Mailings     o Food Drives     o Data Entry/Clerical 

Are you available year round?  Yes______  No ______  If no,when?_____________________

Time (s) and Day (s) available for volunteer service.  Please specify hours that you can volunteer.

I have completed this application to the best of my knowledge, and verify its contents.  I hereby authorize the Foodbank of Monmouth & Ocean Counties to investigate all statements.  I am also authorizing the Foodbank of Monmouth & Ocean Counties to contact employers and/or volunteer organizations listed to verify statements or provide information.

Applicant Signature ____________________________________  Date:______________________