Volunteer Application

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Alternate Phone

(###)

###

####

Are you 18 years of age or older? *

Yes

No

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Emergency Contact Alternative Phone *

(###)

###

####

Select highest level of education completed

High School

Trade School

College/University

Graduate School

Do you have a location preference for a volunteer assignment?

Apple Valley

Brooklyn Park

Eagan

Oakdale

Shoreview

St. Paul

Would you like us to inform your employer of your volunteer service?

Yes

No

Does your employer have matching grants for employee volunteer time?

Yes

No

Which days are you available to volunteer?

Monday

Tuesday

Wednesday

Thursday

Friday

Authorization *

Please read carefully before submitting your volunteer application. I certify, to the best of my knowledge, that the statements contained on this application, are true and complete. I understand that any false statement, omission or misrepresentation on my application or in an interview is sufficient cause for MSS to refuse my request to volunteer. I understand that I may need to supply additional information, and that failure to provide truthful and complete information may result in withdrawal of the volunteer position no matter when discovered by MSS. I understand that some positions will require successful completion of a criminal background check, as required by MSS and the MN Department of Human Services. I agree to supply the information needed to complete that check and to authorize MSS and the Department of Human Services to conduct the background study. I understand that this is an application for a volunteer opportunity and that MSS has made no commitment or promise of assignment to a volunteer position. I agree to adhere to the policies and procedures of MSS and I agree that my volunteer status can be terminated, with or without cause, and with or without notice, at any time by MSS. By selecting the checkbox below, this is evidence that I have read, understood, and agree with the above statements.

I agree