“We Deliver” Volunteer Application * Starred fields are requiredPersonal InformationName* First Last Date of Birth* MM slash DD slash YYYY Address Type*Home AddressBusiness AddressAddress* Street Address City State / Province / Region ZIP / Postal Code Phone - Mobile*Phone - HomePhone - BusinessEmail Address Type*Personal Email AddressBusiness Email AddressEmail* Demographic InformationGender* Female Male Other Race/Ethnicity* African American Asian / Pacific Islander Hispanic / Latino Native American White / Caucasian Multi Racial Prefer not to disclose Professional BackgroundEmployment Status Employed working Part-time Employed working Full-time Not employed, looking for work Not employed, not looking for work Retired Student Disabled, not able to work Place of Employment Background InformationAre you willing to undergo a background check?*YesNoHave you previously been convicted of a crime?*YesNoIf yes, list the police agency, crime charges, date of arrest and disposition of case:AvailabilityHow long are you available to volunteer?*3 months6 months9 months1 yearOngoingVolunteer DetailsDo you have a reliable car to use?*YesNoWhat language(s) do you speak fluently?If English is the only language you speak, please leave the following field blank. Volunteer AgreementI certify that I have answered truthfully and have not knowingly withheld any information relative to my application. I understand that any misrepresentation or material omission on the application will result in my being eliminated from further consideration. I also understand that, if I am accepted, any misrepresentation on my application or in an interview that becomes known to Store to Door may result in immediate dismissal. I agree to abide by existing and future instruction, rules and policies of Store to Door. I understand that my position can be terminated at any time, at the discretion of Store to Door or myself. I agree that I offer my services as a volunteer with no expectation of monetary compensation and that I fully understand that I will be required to attend orientation and training. I agree to Store to Door’s use of photographs of me with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content. I authorize Store to Door to use and publish the same in print and/or electronically. BY SUBMITTING THIS APPLICATION I CERTIFY THE TERMS GIVEN ABOVE FOR APPLICATION RELEASE INFORMATION.NameThis field is for validation purposes and should be left unchanged.