Volunteer Application Form

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Please complete the following form to apply to volunteer with USO of Missouri.

Basic Information

Name: *

Gender:

Female

Male

Home Phone: *

Cell Phone: *

Home Address

Number and Street: *

City: *

State: *

ZIP: *

Email Address: *

Your Birthdate: *

(Volunteers must be 18 years old. There is no maximum age restriction whatsoever. We need to know your age for statistical purposes only. This information will be kept confidential.)

Employment

Are you employed outside the home: *

Yes

No

If yes, workplace:

Position:

Length of time employed there:

Work phone:

Can we call you at work:

Yes

No

Emergency Contact

Name: *

Relationship: *

Phone: *

Do you have any volunteer experience:

Please list nonprofits, dates involved, responsibilities

Do you have any physical limitations: *

Yes

No

If so, please describe:

Why are you interested in volunteering at this time: *

How did you hear about the USO: *

References

Please list the names, telephone numbers and addresses of three people, other than relatives, who have known you for several years. If employed, please include the name of your present employer as one reference.

Note: These responses will be kept confidential by James S. McDonnell USO.

Reference 1 Name: *

Reference 1 Phone: *

Reference 2 Name: *

Reference 2 Phone: *

Reference 3 Name: *

Reference 3 Phone: *

I give permission for the USO of Missouri to contact any of the above individuals:

Yes

Background

Have you ever been convicted of a criminal offense (felony or misdemeanor): *

Yes

No

If yes, please describe the crime -- state the nature of the crime(s), when and where convicted and disposition of the case:

(Note: No applicant will be denied volunteerism solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

I will agree to a police/criminal record check:

Yes

No

Certification:

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not accepting me or for immediate termination of volunteerism at any point in the future if I am accepted. I authorize the verification of any or all information listed above.