Volunteer Profile

Sex: Male Female

Mailing Address:

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip:

Street Address (if different):

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip:

County:

Daytime Phone #:

Evening Phone #:

Cell Phone #:

Best # to use to reach you: Cell Day Evening

Drivers License #:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Commercial: Yes No

Are you over 21? Yes No

If under 21, Birthdate: Month Day Year

Email address:

I am available to work the following times: [Check all that apply]

Monday:	Morning Afternoon Evening Overnight
Tuesday:	Morning Afternoon Evening Overnight
Wednesday:	Morning Afternoon Evening Overnight
Thursday:	Morning Afternoon Evening Overnight
Friday:	Morning Afternoon Evening Overnight
Saturday:	Morning Afternoon Evening Overnight
Sunday:	Morning Afternoon Evening Overnight

Other, Please specify:

How many hours per week/month are you interested in volunteering:
hrs per week or hrs per month or whatever is required hrs

Which age group would you prefer to work with? [Check all that apply]
Children under 15 Teens 15-18 Adults Seniors over 62

What areas of volunteerism are you interested in? [check all that apply]
Accounting / Bookkeeping
Advocacy
Ambulance Attendant / Driver
Board Member
Board training
Clerical Support
Childcare / Babysitting
Computer data entry
Computer web site design / Maintenance
Construction / Renovation
Cooking (for events)
Disaster Team
Event assistance
Event Facilitator
Fire fighting
Fire police
Fund raising
Gardening
Grant research / Writing
Handyman / Maintenance
Interview Facilitator
Job Description Developer
Legal – general
Legal – ‘Wills for Heros’
Newsletter design
Old vehicle maintenance (antique fire truck / classic ambulance)
Phone work
Photographer
Professional development
Proofreading
Public Education Coordinator
Public Educator: general public
Public Educator: schools
Public relations / Marketing
Purchasing and Inventory control
Research
Volunteer development
Volunteer Incentive Program facilitator
Volunteer Placement Coordinator
Volunteer recruitment
Volunteer Retention Facilitator

IF you don’t see what you are interested in the listing, describe what you would like to do:

Is there a specific type of volunteer emergency service organization that you would prefer to volunteer with? Check all that apply.
Critical Response Network
Fire Department
Ambulance Service
Disaster Response Team
Medical Reserve Corps
Search and Rescue Team

Would you be interested in/available for travel outside of the Hudson Valley if the volunteer opportunity required it?
Yes No

I would prefer to volunteer from my home: Yes No

Languages spoken other than English?

Do you have any health related issues or physical limitations that may affect your volunteer work?

Please list any skills you have that you would like to use/share as a volunteer?

What skills would you like to develop as a volunteer?

Please complete the following sentence: I would like to be a volunteer (because, in order to, etc.)

What would you like to get out of being a volunteer?

Current Employer:

Job Title:

Years with this employer:

Employer Contact:

Employer Phone #:

Personal References: (three) Please provide Name, relationship, daytime phone # including area code

Name	Relationship	Daytime Phone

What is your highest level of education:

Do you have your own transportation? Yes No

I am currently (or have been in the last ten (10) years) a member of the following volunteer, paid commercial, or municipal emergency services organizations: (list all including organization name, dates of membership or employment, city and state)

Have you ever had your membership in any volunteer organization terminated by the organization?
Yes No

If yes, please give name of organization and explain reason for termination:

How did you hear about Critical Response Network? [Check as many as apply]
Billboard where:
News release where:
Newspaper article where:
Web search
Class where:
Friend
Other:

Are any members of your family current or past members of an emergency services organization?
Yes No

If yes, which organization(s)?

I have been convicted of a felony(s): Yes No

If yes, please explain:

I understand that:

• by submitting this profile I am asking CRN to identify potential volunteer opportunities either with CRN or with a volunteer emergency services organization.
• CRN does not discriminate based on sex, marital status, sexual orientation, or race and that certain volunteer opportunities may be restricted based on physical and/or mental condition and other factors.
• If I decide to apply for membership with, or for a volunteer opportunity with, an emergency services organization, I may need to complete that organization’s application process. I understand that acceptance by that organization is at their sole discretion.

Please choose a username and password

Username:

Password:

Retype Password:

Please select a question that we can ask to confirm your identity if you lose your password.

Please provide the answer to the question you selected:

Would you like to receive our volunteer e-newsletter? Yes No

Would you like to receive our General Public information e-newsletter? Yes No