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Would you like more information on special events at CYC?
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No
Volunteer Interests
Any Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Area of Study
Name of School
Highest Level Completed
Career Field
Length of Time in Field
Name of Employer
Position
Length of Employement
Previous employment experience in career field (organization, position, length of employment)
Would youth be able to attend career related organizational meetings with you?
Yes
No
Maybe
N/A
Does your employer have a corporate match program?
(check all that apply)
Other Skills
Languages Spoken
(choose all that apply)
Other Interests
Clubs and Organizations
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Previous Volunteer Experience (Organization, Duties, Length of Service)
Why are you interested in volunteering for CYC?
How did you hear about us?
How did you hear about us?
Civic Group or Organization
CYC Participant
CYC Partner (ISU Extension, Kiwanis, Silver Cord, UCAN, United Way, Chrysalis, etc.)
School
Other
Emergency Contact Name
Emergency Contact Home Phone
Emergency Contact Cell Phone
Relationship
REFERENCE 1- NAME
Email
Telephone
Occupation
Number of years aquainted
REFERENCE 2-NAME
Email
Telephone
Occupation
Number of years aquainted
REFERENCE 3-NAME
Email
Telephone
Occupation
Number of years aquainted
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Are you a Veteran?
Yes
No
Is English your first language?
Yes
No
Have you ever been convicted of a misdemeanor or felony or have you been under the supervision of the correctional system?
Yes
No
Have you ever been convicted and/or charged with child abuse or neglect?
Yes
No
If transporting youth as part of your volunteer assignment, has your driver's license ever been suspended or revoked?
Yes
No
If you answered yes to any question above, please explain:
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