Moving individuals & families in St. Louis County toward progress & prosperity by providing community resources

Volunteer Application


PERSONAL INFORMATION
Date:
Name:
Address:
City:	State: Zip:
Phone Number:
Email:
Current School or Place of Work:
Occupation (title and organization):
Work Address:
Work phone:
Work Hours:

ASSIGNMENT REQUEST:

Volunteer position(s) applied for or type of volunteer work desired:

Type of assignment: Volunteer Internship Practicum

Date you are available to start assignment:

Are you required to complete a certain number of hours ?

YES NO

Number of hours you are required to complete:

Projected date of completion of assigned hours:

Have you ever previously volunteered for CAASTLC, Inc., STEP, Inc. or Metroplex, Inc.?

YES NO

Have you ever been convicted of a crime?

YES NO

If yes, please explain (a conviction will not automatically bar your participation as a volunteer, intern, or practicum student.):

Can you submit legal proof of identity?

YES NO

Do you possess a valid Driver's license?

YES NO

Issuing state:

Do you have current automobile insurance?

YES NO

If you have been assigned to do court ordered community service please give contact information for your P.O.

Name:
Phone#:

If you are an internship or practicum student please give contact information for your school department head or administrator to whom you will report your hours of completed work.

Name:
Phone#:

If you are an independent volunteer, how were you referred to us?

Volunteer/Relevant Experience

1.	Organization:
	Address
	Phone #
	Person you reported to:
	From: to
	Duties:

2.	Organization:
	Address
	Phone #
	Person you reported to:
	From: to
	Duties:

3.	Organization:
	Address
	Phone #
	Person you reported to:
	From: to
	Duties:

4.	Organization:
	Address
	Phone #
	Person you reported to:
	From: to
	Duties:

REFERENCES List three (3) references (do not include relatives or employers).
Name:
Address:
City:
State:
Zip:
Telephone:

Name:
Address:
City:
State:
Zip:
Telephone:

Name:
Address:
City:
State:
Zip:
Telephone:

EMERGENCY RECORD In case of emergency notify:
Name:
Relation:
Address:
City:
State:
Zip:
Telephone:

UPLOAD YOUR RESUME TO CAASTLC, Inc. If you have a resume and would like to include it with your application please use the box below
Attach Cover Letter:
Attach Resume:
	(Must be a Microsoft Word Document (.wpd), Word Perfect Document (.wpd), or Text File (.txt or .rtf))

I hereby authorize CAASTLC, Inc. to contact, obtain and verify the accuracy of the information contained in this application from all sources. I also hereby release from liability CAASTLC, Inc. and its representatives for seeking, gathering and using information to make assignment decisions and all persons or organizations for providing such information.

If I am assigned as a volunteer, intern, or practicum student, I acknowledge that there is no specific length of assignment and that either I or CAASTLC, Inc. can terminate this assignment at any time for any reason. I understand that this application is only for requesting assignment at CAASTLC, Inc. as a volunteer, intern, or practicum student.

I understand that if I am accepted as a volunteer, intern, or practicum student, I will be required to provide satisfactory proof of identity. I represent and warrant that I have read and fully understand the foregoing.

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