SAN DIEGO ARMED SERVICES YMCA

APPLICATION FOR VOLUNTEER SERVICES

Date____________
This association does not discriminate in securing volunteers on the basis of race, color, religious creed, national origin, sex, or ancestry; or
on the basis of age against persons whole age is over 40 or on the basis of handicap or disability and any other characteristic required by
law. No question on this form is intended to secure information to be used for such discrimination.

1. Name (in full): ______________________________________________________________________________________

Last First Middle
2. Residence: __________________________________________________________________________________________
Street Address City State Zip

3. Telephone Numbers: Cell __________________________________ Home ________________________________

4. Email Address: ________________________________________ 5. Date of Birth: __________ 6. Military: Y __ N __

7. How did you hear about our volunteer program? ____________________________________________________________

8. Why are you interested in volunteering for the San Diego Armed Services YMCA?
_____________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

9. Please indicate your reasons for wishing to become a volunteer:

___ Social Responsibility ___ School Requirement ___ Other

10. Please check the type of volunteer work you are interested in:

___ Pediatrics ___ Ambassadors of Patient Care ___ Healthy Living ___ Wounded Warriors
___ Patient Recreation ___ Transportation Program ___ Youth Development ___ ASYMCA Office
___ Hospital Activities ___ Neighborhood Exchange ___ Special Events ___ Other

11. Describe previous volunteer experience:

_____________________________________________________________________________________________________

12. Length of time you are willing to commit to volunteering: __ less than 6 months __ 6 months to 1 year __ 1 year +

13. Do you have any physical restrictions that require accommodation? ___________________________________________

14. Are you certified in any of the following? First Aid CPR Pediatric CPR Lifeguard

15. Have you ever been convicted or any criminal offense other than the following: minor traffic violations fine $500.00 of
less; or offenses settled in juvenile court or under welfare youth offender law? Yes No
If yes, please explain. __________________________________________________________________________________

16. REFERENCES (exclude relatives)

a) __________________________________________________________________________________________________
Name Occupation Cell Phone Work Phone
b) __________________________________________________________________________________________________
Name Occupation Cell Phone Work Phone

17. Do you have a valid driver’s license? Yes No # _____________________________

18. Do you have a valid Class 11/B license in this state? Yes No #______________________________

PLEASE EMAIL COMPLETED APPLICATION TO TASHA LEON-GUERRERO:

NATASHA.LEONGUERRERO@MED.NAVY.MIL
IN COMPLIANCE WITH U.S. DEPARTMENT OF TRANSPORTATION FHWA, THE ASYMCA WILL CONDUCT PRE-AGREEMENT DRUG TESTING AND RANDOM
DRUG AND ALCOHOL TESTING OF BUS DRIVERS