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Ohio Heartland CAC
Head Start
Volunteer Application
Date:
Male:
Female:
Name:
Date of Birth:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail:
Languages Spoken:
Employer:
Phone:
Position:
Please list two personal references:
(other than family members)
Name
Address
City/State/Zip
Phone
1
2
Have you ever been convicted of a criminal offense (misdemeanor or felony):
Yes
No
Date of Conviction:
Name/Address of Court:
Nature of Offense:
When are you available to volunteer?
(enter time of day)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
Afternoon
Evening
How often would you like to volunteer?
Weekly
Monthly
Please check the area in which you would like to volunteer.
Classroom Reader
Classroom Activities
Translation, Interpreter
Office Assistant
Computer Lab Aide
Building Fix-up & Repair
Parent Trainer
Head Start Activities
Other
List other groups or organizations to which you belong.
How did you hear about Head Start?
