Please complete this application form if you are interested in becoming a Charles W. Eisemann Center volunteer. Once you complete the form, click the submit button at the bottom. All applications are reviewed by Eisemann Center House Management. We will contact you to arrange a New Volunteer Orientation where you will receive additional information about our program. Note: all EC Volunteers must pass a criminal background check to volunteer at the Eisemann Center.

You must be 16 years of age to volunteer per the City of Richardson. Commitments of 6 months to a year are preferable.

Name and address

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

Demographic

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

Gender:

Education:

Marital Status:

Emergency Contact Information

Please give us two emergency contacts. Remember most events will be in the evenings or on weekends.

1

2

First name:

Last name:

Home phone:

* OK to call here

Home phone:

* OK to call here

Cell phone:

* OK to call here

Cell phone:

* OK to call here

Relationship:

How Did You Hear About Us?

Please let us know how you learned about the Eisemann Center's Encore Volunteer Program.

Preview of the statement of agreement

As a Volunteer at the Eisemann Center, I agree to be responsible in fulfilling my commitment to the volunteer service to which I have been assigned or which I have selected.

In the case that I am unable to meet any scheduled assignment, I will make every effort to contact Eisemann Center House Management within a reasonable time frame, so a replacement can be found.

I will read and will abide by the policies stated in the Volunteer Handbook and fully understand my responsibilities.

I will represent the Eisemann Center to the general public in a professional and appropriate manner.

As the Volunteer’s sponsoring agency, the Eisemann Center agrees to maintain a safe and comfortable work environment; to provide training, guidance, and reasonable care for all volunteers; and to offer opportunities for meetings, discussions and recognition activities.

After your orientation you will be given a copy to sign for our files.

I Agree