Address: Home Phone:
Employer: Work Phone:
Are you under 18 years of age? ☐ Yes ☐No
Have you ever been convicted of a crime more serious than a minor traffic violation?
☐ Yes ☐No
(A criminal record does not constitute an automatic bar to being accepted as a volunteer.)
If yes, please specify date, charge, place, and action taken:
Person to contact in case of emergency:
Name: Home Phone:
Relationship: Work Phone:
☐High School ☐ Attending College ☐College Graduate ☐Technical/Trade School
I am now studying at:
Subject/Major: ☐ Full Time ☐Part Time
Number of hours enrolled:
Return questionnaire to: Questions:
Historic Rugby Call (423) 628-2441
PO Box 8 Email: email@example.com
Rugby TN 37733
Do you have previous historical society/museum experience? ☐ Yes ☐ No
If yes, where have you worked and in what capacity?
Previous Volunteer Experience:
(Please complete in full, starting with your most recent volunteer experience.)
|Organization Name||Dates of Service||Volunteer Duties||Supervisor Name and Phone #|
Which days would you like to work? (Please circle.)
M T W TH F SAT SUN
What time of day would you prefer? (Please circle.)
Mornings Afternoons Evenings
What type of projects do you prefer? (Check all that apply.)
Long term projects (several weeks) Short term projects (a few hours)
Ongoing projects (2-4 hours weekly/monthly) One time project (special event)
Type(s) of volunteer opportunities interested in: (Check all that apply.)
Special Events Clerical Support Library Cleaning
Gardens Visitor Centre Print Shop
List any experience and/or special skills that you can bring to us!
I certify that the statements made in this volunteer application are true and correct and have been given voluntarily. My services are donated to Historic Rugby without contemplation of compensation or future employment and given with charitable reasons.
Applicant’s signature: ____________________________________________
Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, gender, or disability.