Volunteer Application Apply to Join As J.E.S.S.I.C.A. Volunteer Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLast Organization: & have Email *Name of Guardian (if under 18 years of age)Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCompany/Volunteer Group NameDate of Birth *Driving License NumberPhone Number *Emergency Contact Number *Do you have any friends/family volunteering at JESSICA? *YesNoDont KnowIf Yes, please provide name(s) When are you available to volunteer (specify hours)? Monday 012345678Tuesday012345678Wednesday012345678Thursday012345678Friday012345678Saturday012345678Sunday012345678Types of volunteer work you would be most comfortable with: *Helping with a workshop/academyAdult Chaperone at the Annual RetreatAssisting in Fundraising ActivitiesChairing a CommitteeServing on a Committee (Marketing, Outreach, Fundraising, Event) Past Volunteer Experience: Organization:Duties:Dates Have you ever been convicted of a crime? *YesNoIf yes, please describe: References: (List two people, not related to you, who have knowledge of your qualifications) Reference 1 Name, Phone, & Mailing Address: *Reference 2Name, Phone, & Mailing Address: *I need the following accommodation(s) to work as a volunteer:Agreement & Waiver *I Agree to the following terms & ConditionsAs a volunteer for J.E.S.S.I.C.A. Cares, I agree to abide by all applicable rules and regulations of the agency. I understand that I will receive no monetary benefits in return for my volunteer service. I hereby authorize J.E.S.S.I.C.A. Cares to check my references. I certify that my answers on this application are true and complete and that I have not knowingly withheld any information that might, if disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application could be a cause for rejection of this application. I hereby release and waive liability against J.E.S.S.I.C.A. Cares, a non-profit organization, its directors, officers, employees and agents, its successors and assigns, for any injuries or illness that I myself or my dependent may suffer in connection with any volunteer work for J.E.S.S.I.C.A. Cares. Further, I agree that J.E.S.S.I.C.A. Cares is not liable for any damage to my property or my dependent's property resulting from volunteer work for J.E.S.S.I.C.A. Cares.Join JESSICA as a Volunteer
