Contact Us
Online Payment
Request Information

Donate Now

View All Professional Seminars

Youth Mental Health First Aid

Register for On Your Mark, Get Set, GLOW Run/Walk 2017!!

2016 On Your Mark, Get Set GLOW Video

2017 On Your Mark, Get Set, GLOW Sponsors

Mental Health First Aid

Depression Screening Questionnaire

2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 

Volunteer Application

To Applicant: We appreciate your interest in our organization and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the volunteer position that best meets your qualifications.

Personal

First Name:
Middle Initial:
Last Name:
Present Address:
City:
State:
Zip:
Home Telephone:
Work Telephone:
Cell Phone:
Email:

Sex : Male Female

Age (if under 18):

Why are you interested in becoming a volunteer at Brook Lane?

How did you learn about the Brook Lane Volunteer Program?



General Information and Volunteer Availability Please check the area(s) you would like to work:
Tutoring Interpreting
Arts/Crafts Classroom/Library Assistant
Gardening Fundraising
Clerical Duties Event Organization

Please list available hours.

Morning Afternoon Evening
 
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Special Skills / Hobbies:



Education

Education Completed: grade school high school college other
If Other:


Employment History (past employment, internships and/or volunteer experience)
Company
Address:
City:
State:
Zip:
Telephone:

Dates employed:

Describe the work you did:

Type (Employment, Internship or Volunteering):



Company
Address:
City:
State:
Zip:
Telephone:

Dates employed:

Describe the work you did:

Type (Employment, Internship or Volunteering):

 


Company
Address:
City:
State:
Zip:
Telephone:

Dates employed:

Describe the work you did:

Type (Employment, Internship or Volunteering):

 


May we contact the employers above?

If not, indicate which one(s) you do not wish us to contact?

 


 

References (Please do not use relatives)
Name:
Address:
City:
State:
Zip:
Telephone:
Email:

Name:
Address:
City:
State:
Zip:
Telephone:
Email:

Name:
Address:
City:
State:
Zip:
Telephone:
Email:

 

Please read below:

We appreciate your interest in volunteering with Brook Lane.

  1. I give permission to Brook Lane to investigate any and all information concerning my application in order to determine my qualifications. This includes, but is not limited to TB testing, criminal background, employment, and personal reference checks. Some placements may require a drug test. I understand any misrepresentation of facts contained in this application may be cause for my rejection or dismissal.
  2. I agree to be photographed by Brook Lane.
  3. I agree to abide by all Brook Lane policies and regulations. I understand that this application and any other such documents are not contracts of employment, and that any volunteer who is placed may voluntarily leave, and/or may be dismissed by Brook Lane at any time for any reason.
  4. In the event of resignation or dismissal, I agree to return all Brook Lane property loaned to me.

My signature or typing of my name on electronic application indicates that I have read, understood, and consented to the above statements. This authorization or photocopy shall serve as consent for Brook Lane to request any information concerning my application.

I have read and agree to the terms above (required for submission)


Name:     Date:  

 

1-800-342-2992
(301) 733-0330
FAX (301) 733-4038

13121 Brook Lane
P.O. Box 1945, Hagerstown, MD 21742

Contact Us.





Home | Site Map | Contact Us
Copyright 2014. Brook Lane.
Website Design by High Rock