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American Red Cross: Penn-Jersey Region Volunteer Application
First name:
Last name:
Home phone:
Cell phone:
Business phone:
Address:
City:
State:
Zip:
Business e-mail:
Home e-mail:
Date of birth:
References (work or personal)
First name:
Last name:
Day phone:
Evening phone:
Relationship:
Emergency contact
First name:
Last name:
Day phone:
Evening phone:
Relationship:
Volunteer General Information
Select a job type (check all areas of interest)
Availability dates/times
Blood mobile
Fixed donor centers
Office volunteer
Training team
Recruitment team
Newsletter editor
Transportation specialist
Skills (check all that apply)
Computer
General office
Research
Desktop publishing
Training
Public speaking
Telephone
Scheduling
Registration/reception
Writing
Transportation(driving)
Canteen(donor refreshment)
Blood Mobile Volunteers Only
Can you volunteer in Center City?
Yes
No
If no, would you volunteer in Center City if transportation was provided?
Yes
No
Do you have a car?
Yes
No
If you have a car, would you be able to take other volunteers in your area to the blood mobile?
Yes
No
Transportation Specialist Volunteers Only
Can you pick up blood in your area?
Yes
No
Can you pick up blood in Center City?
Yes
No
Can you pick up and return volunteers?
Yes
No
Do you have access to a car for your use?
Yes
No
If yes, please provide your driver's license #:
Special note on Transportation Specialist positions. All volunteers who would like to perfomr these activities must authorize a DMV check. An American Red Cross representitive will contact you to obtain your signed permission for the DMV check.
All Volunteers
Are you interested in Volunteer Leadership opportunities?
Yes
No
If yes, to the above question, please tell us about your leadership skills.
How did you hear about the American Red Cross?
Web search
Community organization
Employer
Email from a friend
Link/reference on a website
Search engine
Magazine
Newspaper
TV
Radio
Other
If you selected "other", please describe below:
Do you have a friend that might want to learn more about our volunteer opportunities?
Yes
No
If yes, please provide the following information:
First name:
Last name:
E-mail:
Contact #:
Do you belong to a professional group or community center that might be interested in learning more about our volunteer opportunities?
Yes
No
If yes, please provide the following information:
Name of group or community center:
Contact first name:
Contact last name:
Contact email:
Contact phone #:
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© 2008 American Red Cross, Penn-Jersey Blood Services Region
700 Spring Garden Street, Philadelphia, PA 19123 - (215) 451-4000