Name:                                                                                        Date:

Home Address:

School Address – if college student: 

Date of Birth:

Home Phone:                                                                         Work Phone:

Cell Phone: 

Email address:

Highest Level of Education:

Social Security Number:

EMPLOYMENT

Provide information on your current employer, if applicable in the space below:

Position/Title:

Dates of Most Recent Employment (starting/ending):

Company/Employer: 

Address: 

Would you like us to keep your employer abreast of your volunteer service and achievement?                  Yes                     No

Schooling

Provide information on your current schooling, if applicable, in the space below:

Current grade/level:

Name of school: 

Address of school: 

Other areas of interest

Special training, skills, hobbies and interests:

Groups, clubs, organizational memberships: 

Please describe your prior volunteer experience (include organization name and dates of service):

What experiences have you had that may prepare you to work as a volunteer in the field of service dog training/disability service:

Why do you want to volunteer at Promising Partners Assistance Dogs?

Are you interested in becoming a Puppy Home or Temporary Puppy Home? 
______Yes ______No

Are you a member of, or do you support financially, any animal rights organizations? (example PETA)                 Yes                 No

If yes, please explain in detail the level of your involvement: 

Have you ever been convicted of a crime? (If yes, please explain the nature of the crime and the date of the conviction and disposition). Conviction of a crime is not an automatic disqualification for volunteer work.

Do you have a driver’s license: ________Yes ________No

License #:                                                                                State:

Car insurance: _________Yes _________No

Health insurance: _________Yes _________No

References: Please list three people who know you well and can attest to your character, skills and dependability. Include your current or last employer. Not more that one relative:

Name/Organization 

Relationship to you  

Phone

Length of relationship

Please read the following carefully before signing this application:

I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Promising Partners that is true, correct and complete to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Promising Partners.  I understand that misrepresentation or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Promising Partners or my termination as a volunteer.

Signature:                                                                                      Date:

If under 18 years of age, signature of parent/legal custodian is also required.

Signature:                                                                                      Date: