PIRS Volumteer Application

It is the policy of PIRS to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion national origin, or other protected classification.

Date:

Name:

Address:     [apt. #]:

City:     State:     Zip Code:

Phone Number: ()-

Email address:

Driver License Number (if relevant to duties to be performed):

Emergency Contact: Phone:()-

Accommodation Needed?


Languages Spoken: Spanish French Asian (type) Sign Other

Volunteer Background: Please attach resume also, if available

Referral (How did you find us?):

Days/Times Available: M T W TH F AM 8:30 - 1 PM 1 - 5 Other

Comments:

 


PIRS Volunteer Skills and Interest List

Typing/keyboarding Words Per Minutes

Computer Skills: MS Word MS Access (Data Entry) Other:

Clerical Support:

Receptionist:

Bulk Mail Preparation:

Research (describe):

Transcibing (documents, audio recording, Braille):

Reading/Writing (correspondence, etc. for those with visual disabilities:

Systems Advocacy (phoning, letter writing, speaking or arranging for speakers, support in organizing events, etc.):

Field Surveys (training and mileage reimbursement provided):

Public Relations:

Peer Support (Must have a disability): :

Fundraising:

Photography:

Accounting:

Legal services:

Carpentry/Handyman:

Interpreting - describe languages and level of skill:


Other:


APPLICANT'S CERTIFICATION AND AGREEMENT

I certify that the facts set forth in this Application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in my dismissal I authorize PIRS to make an investigation of any of the facts set forth in this application.

 


PLEASE FILL OUT THIS FORM, PRINT AND MAIL IT TO:


EMPLOYMENT APPLICATION

C/O Placer Independent Resource Services
11768 Atwood Rd. #29
Auburn, CA 95603



   
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Placer Independent Resource Services
Updated: June 20th, 2016