Volunteer Application

Name *

First Name Last Name

E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number

Date of Birth *

Education/Training

Occupation

Are you a veteran? *

Yes No

If yes, with which branch of military did you serve and how long?

Thank you for providing the following information; Compeer volunteers often drive their client-friend to social outings.

Do you have use of a car? *

Yes No

Do you have a current driver's license? *

Yes No

Has your license ever been suspended? *

Yes No

If yes, please explain:

Have you ever been convicted of a crime (except minor traffic violations) or have any pending charges against you now? *

Yes No

If yes, give date and nature of charge:

Please list any foreign languages you speak, including American Sign Language:

Please share your hobbies, clubs special interests, skills, etc.

How did you learn about Compeer?

Compeer of Lebanon County is aware of the sensitive nature of some of the questions asked. It has been our experience that having as much ifnormation as possible about each individual, whether volunteer or client, increases our ability to match people successfully. All information is requested to ensure, to the greatest degree possible, the success of the matching process. Information will be kept confidential.

During the volunteer process, Compeer of Lebanon County will conduct a Pennsylvania Background Check to verify information submitted.

Compeer does not discriminate on the basis of age, gender, enthinicity, religious affiliation or sexual orientation.

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