JFCAC Head Start Volunteer Application - JEFFERSON FRANKLIN COMMUNITY ACTION CORPORATION

Jefferson Franklin Community Action Corporation

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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 *

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 *

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 *

Signature: (Type Your Name & Today's Date) *

Your Signature Is Required to Submit This Form.

Submit Application

JEFFERSON FRANKLIN COMMUNITY ACTION CORPORATION
#2 MERCHANT DRIVE P.O. BOX 920, HILLSBORO MO 63050
PHONE: 636-789-2686
RELAY MISSOURI TTY SERVICE 1-800-735-2966/ 1-800-735-2466
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JFCAC IS AN EQUAL OPPORTUNITY EMPLOYER

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