Community Service Application To get started with your Community Service Worker application, please fill in the form below. Name First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone - homePhone - cellPhone - workDate of birth Name of organization to report hours to:Name of contact within organization:How many hours are required?By what date do you need to complete your hours? Please indicate any medical restrictions you have: Please indicate which department you would like to work with. (Please check all that apply.) Food Pantry Donations Garden Driving & Pick Up Cleaning/Indoor Maintenance Outdoor Maintenance As Needed Please list/describe the days/times between Monday and Friday that you are available. Please read the following carefully before signing this application: Community Service Workers must be at least 16 years old unless prior approval from a primary staff person has been obtained as well as adult supervision. Background checks: The Neighbors' Place will do a routine background check on all Community Service Workers for the safety of our clients, staff, and other volunteers. This information is kept in the strictest confidence. Confidentiality is a very important aspect of our services. Because of the nature of the business that is conducted at The Neighbors' Place, it is required that all information that you hear or read in reference to any client, volunteer, or donor at The Neighbors' Place be kept in strict confidence. If you violate this rule, you will be asked to not volunteer here any longer. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a Community Service Worker position. I understand that The Neighbors' Place will verify information I include in my application. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant with The Neighbors' Place or my termination as a Community Service Worker.Agreement with terms and conditions* I agree with the terms and conditions mentioned above. Signature* NameThis field is for validation purposes and should be left unchanged.