Alabama Head Injury Foundation

AHIF Volunteer Application

PERSONAL INFORMATION
*Today's Date
*Last Name
*First Name
M.I.
Address
City
State Zip
Birthday	month day
*Preferred method of contact:
*Home phone		Cell phone
Work phone		Fax number
*Email Address
Do you check your email daily?	Yes No	Age (optional)
Have you previously been employed or volunteered for AHIF? Yes No
If Yes, when and where?
Have you ever been convicted of a felony? Yes No
If yes, explain.
How did you learn about our volunteer program? Media Friend Web page AHIF newsletter Other, please explain.
VOLUNTEER EXPERIENCE
Please list previous Volunteer experiences. Include organization, your involvement and length of time you volunteered.
List any special skill you possess or language in which you are fluent that would be an asset to the AHIF Volunteer program.
Briefly state why you would like to volunteer for the Alabama Head Injury Foundation.
Areas of interest? Clerical Direct Client Service Fund Raising/Events Public Awareness Recreation Other
REFERENCES List 3 references who are aware of your work or volunteer experiences. You may include professional, volunteer, educational, or employment contacts. Please do not include friends or family. Provide daytime telephone numbers.
Name
Address
City
State Zip
Phone
Email
How do you know this person?

Name
Address
City
State Zip
Phone
Email
How do you know this person?

Name
Address
City
State Zip
Phone
Email
How do you know this person?
VOLUNTEER APPLICANT'S STATEMENT
I understand that I am applying to be an unpaid volunteer for the Alabama Head Injury Foundation and that this application is not an application for employment. I understand that nothing in this application is intended to imply or create an employment relationship or a contract for employment. For certain positions, the Alabama Head Injury Foundation conducts background checks on potential volunteers. If this applies to you, another form will need to be completed. The information I have provided on this application form is true and complete. I hereby give the Alabama Head Injury Foundation the right to check my references and release the Alabama Head Injury Foundation and all persons supplying such information, from liability. I understand that if any misrepresentation has been made by me, I may be disqualified for consideration or dismissed if discovered at a later date. If I am accepted into the Alabama Head Injury Foundation volunteer program, I agree that I will abide by the requirements of the program, policies and procedures of the organization. I Accept I Decline Today's Date:
AVAILABILITY
I am flexible Prefer weekdays Prefer evenings Prefer weekends Other times
There are times during the week that I cannot volunteer:
Do you have access to an automobile that you can use for volunteer work? Yes No
EMERGENCY CONTACT INFORMATION
Contact Name Relationship
Day Phone Evening Phone

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DISCLAIMER: Within this site, there are links to web sites around the world that contain educational and research information. These "outside sites" are not managed by the Alabama Head Injury Foundation. AHIF does not endorse nor recommend the information or products posted on these sites, and receives no payment or other consideration for providing these links.