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. Monday Agreement of Name *FirstLastEmail *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
