Name of Volunteer:_______________________________________________________________

Last First M.I.

Mailing Address:_________________________________________________________________

City:_____________________________ State:____________________ Zip:________________

Home Telephone No.:__________________ Business Telephone No.:______________________

Fax:_________________________________ email:_____________________________________

Volunteer Position Applying For;

_______Volunteer Duty VIS Station Guide _______Stargazing Volunteer _______ Other

Briefly explain you interest in volunteering at the Mauna Kea Information Center:

Education/Training & Specialized Skills: (Proof may be required)

__________High School ____________College ____________Graduate School

Degree(s)________________________________________________________________________

Certification:

_________Driver’s License (___________Type) _____________First Aid _________CPR

_________Other (Specify):_________________________________________________________

Can you operate a four-whell drive vehicle: __________Yes ___________No

Special skills: describe any special skills, e.g. art, writing, computer, foreign languages, etc.

Current Employer:_______________________________________________________________

Current Job Title:__________________________________________________________

Current Work Schedule:____________________________________________________

Name & telephone number of current supervisor:_______________________________

Volunteer Experience – please list dates of any previous volunteer experiences, the agency for which volunteer services were performed and the type of services provided:

Availability for Volunteer Services: days of the week and available hours:

In case of an emergency, who should we notify?:

Name_________________________ Relationship _______________ Telephone No.__________

PLEASE READ CAREFULLY

I certify that the information provided on this volunteer Application is true and any misrepresentation provided on this form may result in my immediate termination as a volunteer. I am authorizing the Project to contact my former and current employer for references. If selected, I will comply with all requirements by my supervisor and acknowledge that the university may, at its discretion, terminate my participation in the volunteer program at any time.

___________________________________________________ ________________________

Signature of Applicant Date

For Internal Use Only

Volunteer Job Title:______________________________________________________________

Date Interviewed:________________________________________________________________

Selected: ___________________ Not Selected: _______________________

Number of Hours of Services:______________________________________________________

Category: ______________Regular-Service _____________Occasional Volunteer

______________Stipend Volunteer _____________Materiel Donor

______________________________________ ________________________

Signature of Manager, VIS Date VolProc990101a