Volunteer Application

 Black Repertory Group

Personal Information  - All fields are mandatory

Position Applied for                   Date of Application

How did you hear about us? Advertisement               Relative                    Internet / Website  Employment Agency    Walk In Friend                             Other - specify

Last Name                                     First Name                                      Middle name

Address.                                                                                                    Town/City                                                               State         Zip Code

Telephone:     Daytime:                                               Evening:                                               Social Security Number

Email address                                              Desired Salary

Skills

Please indicate the skills/activities that you would most like to share with youth/young adults/adults: Acting Class Community Outreach Musical Theatre Homework Assistance Literacy/Tutoring Art Classes Mentoring Comic Classes Performance Workshops String Instruments Public Speaking/Presentations Creative Arts Modeling Classes Dance Percussion Insruments Grant Writting Fund Raising Specialist Other

Are you fluent in any language other than English?                                      Yes       No                                                         If yes, please Specify:

What school/age groups are you most interested in working with?                       Select OneElementaryMiddle SchoolHigh School

What subjects are you interested in tutoring? Basic Math  Pre Algebra  Algebra Geometry Advanced Algebra Trigonometry  Pre-Calculus  Calculus  Statistics   Basic Language Arts Grammar Writing  Reading College Planning   SAT/ACT prep  Musical Theatre History Chemistry Acting Class Creative Arts Dance Physics Performance Art Other

If you are under 18 years of age, can you provide required proof of eligibility to work?         Yes       No

Have you ever filed an application with us before?                  Yes       No                            If yes, give date

Have you ever been employed with us before?  Yes       No                           If yes, give date

On what date will you be eligible for work?

Are you available to work:       Fulltime        Part Tine        Per Diem         Temporary

Can you travel if the job requires it?                Yes       No

If necessary, will you have access to a car?    Yes       No

Education

Name and Address of School Course of Study Years Completed Diploma/ Degree Graduation Date High School Undergrad College Graduate Professional Other (Specify)

Volunteer Experience

Organisation 1                             Dates:                                                              From :    To:  Address Telephone Number(s)           Job Title                                                Supervisor             Tasks Performed Organization 2                             Dates:                         From :    To:  Address Telephone Number(s)            Job Title                                                Supervisor                  Tasks Performed

Employment Experience

Employer 1                                    Dates:                          From:    To:   Address         Telephone Number(s)                       Hourly Salary Rate                              Initial    $      Final $    Job Title                                                Supervisor                      Work Performed Employer 2                                     Dates:                         From:    To: Address   Telephone Number(s)                       Hourly Salary Rate               Initial    $      Final $  Job Title                                                Supervisor                        Work Performed Employer 3                                   Dates:           From:    To:   Address     Telephone Number(s)                 Hourly Salary Rate                    Initial    $      Final $  Job Title                                                Supervisor                     Work Performed

References

Please provide contact information for 3 references. References may be from Supervisors, teachers, mentors, clergy, community leaders, etc. Choose people who have known you for at least one year and will speak form experience to provide specific information about your potential, maturity, commitment, and responsibility.              References may NOT be from people in your family.

Reference 1 Name                                                 Organization         Reference 2 Name                                                 Organization          Reference 3 Name                                                  Organization                                                        Return to Home