Volunteer Application for Child Care Centers
Name*:
Address:
Address (cont):
City, State:
Zip:
Phone(H)*:
Phone(W):
Fax:
E-mail*:
Date of Birth:
Gender:
Martial Status:
Gender:
Number of Children
Names and ages of Children
* required
Please describe your past experience with children:
Please describe your health:
Poor
Fair
Good
Excellent
Do you have any physical limitations or special concerns(describe)?
Are you taking medications on a regular basis(describe)?
Do you have any known allergies(describe)?
How many years of you lived in Colorado?
By checking here you acknowledge that we will be doing a background check with the Colorado Bureau of Investigation and the Central Registry.
Attitudes, Hobbies, Skills
What attitudes and beliefs are of special importance to you?
Please list interests, hobbies, and activities that you pursue.
Do you have any special skills or talents you'd be willing to share?
Employment History
Present Employer:
Address:
Address (cont):
City, State:
Zip:
Phone:
Occupation:
No of Yrs with Employer:
Immediate Supervisor
Previous employment(please list most recent first)
include position, employer, dates of employemnt, and reason for leaving
1.
2.
3.
Education
High School:
Years Attended:
Diploma Received:
College/University/Technical School:
Years Attended:
Diploma Received:
References
Give the name, address and telephone numbers of three references who are not related to you that you have known for at least two years or more.
1.
2.
3.
