Jefferson Franklin Community Action Corporation
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Head Start 2019
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Head Start Volunteer Application
Volunteers MUST be at least 18 years of age.
*
Indicates required field
Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Do you have a child in Head Start?
*
Yes
No
Phone Number
*
Gender
*
Male
Female
Are you a former Head Start Parent or Guardian?
*
Yes
No
Are you the parent of a 0 to 5 year old?
*
Yes
No
Relationship to Child
*
Parent
Guardian
Grandparent
Sibling
Other
Are you Presently Employed?
*
Yes
No
Name of Employer
*
Employer Phone #:
*
Job Title
*
Length of Employment
*
Hours You Work
*
Highest Grade Completed
*
8th
12th
College
Languages
*
Training
*
Skills & Interests
*
Availability
*
Short Term
Long Term
Special Projects
Number of Hours
*
1
2
3
4
5-10
11-and up
Choose One
*
Per Week
Per Month
Type of Work You Would Like (check all that apply)
*
Work with children
Maintenance
Work with Administrative Staff
Other
Other: Please Explain
*
Time You Prefer to Work
*
Flexible
Mornings
Afternoons
Have You Ever Been Convicted of a Crime?
*
Yes
No
If yes, please explain
*
Location You Wish To Volunteer At
*
Any
Desoto
Fenton
Hematite
House Springs
Sullivan
Gray Summit
St. Clair
Union
Windsor
Administration Office
Signature: (Type Your Name & Today's Date)
*
Your Signature Is Required to Submit This Form.
Submit Application
