Please enable JavaScript in your browser to complete this form. – Step 1 of 6I am interested in *Long term volunteeringInterningContact InformationName *FirstLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrimary Phone *Secondary PhoneEmail *Date of Birth *Emergency ContactName *FirstLastPrimary Phone *Secondary PhoneEmail *Relationship *NextAvailabilityShifts you are available? *Monday 8:30a – 12:00pMonday 12:00p – 5:00pTuesday 8:30a – 12:00pTuesday 12:00p – 5:00pWednesday 8:30a – 12:00pWednesday 12:00p – 5:00pThursday 8:30a – 12:00pThursday 12:00p – 5:00pFriday 8:30a – 12:00pFriday 12:00p – 5:00pSaturday 8:30a – 12:00pSaturday 12:00p – 5:00pSunday 8:30a – 12:00pSunday 12:00p – 5:00pAllConsistence *OngoingSporadicOnly between the certain dates** If only between certain dates, please enter timeframes hereI would like to serve up to ________ hours per ________.InterestWhat are you interested in helping with? *Working one-on-one with a RancherLeading enrichment classesEditing of written documentsHorsesTeachingCarpentryFishingRanchingPlumbingHorticultureNature HikesHistoryGrant WritingWord, Excel and general windows softwareElectricialCows, pigs, and goatsAnimal HusbandryA/CMaster GardenerOtherIf choose Other, please explainHave you ever volunteered at DHR? *YesNoIf you answered yes to the above question, please list when.NextEmployment and Volunteer ExperienceProvide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent. Explain any gaps in the comments section below. If additional entries are needed, please upload a document listing additional information.Company #1 *Phone *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob Title *Summarize the type of work performed and job responsibilities *Immediate Supervisor Name and Title *Company #2PhoneAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob TitleSummarize the type of work performed and job responsibilitiesImmediate Supervisor Name and TitleCompany #3PhoneAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob TitleSummarize the type of work performed and job responsibilitiesImmediate Supervisor Name and TitlePlease attach a document showing any additional employment or volunteer History Click or drag a file to this area to upload. NextSkills and QualificationsSummarize any special training, skills, licenses and/or certificates that may qualify you for the internship or volunteer position. Skills include any foreign languages you may speak fluently. *NextReferencesList the name and phone number of three non relative references who are NOT related to you. If not applicable, list three school or personal references.Reference #1 *Phone *Relationship *Number of Years Known *Reference #2 *Phone *Relationship *Number of Years Known *Reference #3 *Phone *Relationship *Number of Years Known *NextHave you ever been convicted of a DUI or DWI? *YesNoHave you ever been convicted of assault and battery? *YesNoHave you ever been convicted of rape or any other sexual offenses? *YesNoHave you ever been convicted of assault with intent to commit rape? *YesNoHave you ever been convicted of possession, distribution and/or trafficking of drugs? *YesNoHave you ever been convicted of intent to commit any of the above crimes? *YesNoHave you ever been subject to any court order involving sexual or physical abuse of a minor, Including, but not limited to, a domestic order or protection? *YesNoHave you ever been convicted of kidnapping? *YesNoHave you ever been convicted of theft? *YesNoHave you ever been convicted of any crime, including sex-related or child-abuse related offenses? *YesNoAnswering “Yes” to the above question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness of the violation, rehabilitation and position applied for will be taken into account.If yes, please explainToday's Date *Signature *Clear SignaturePlease sign your full name in the box above to certify that you have read, fully understand and accept all of the terms of the foregoing.Please list any additional information you would like for us to consider.All applicants must consent to a background check.Online Signature by eSign Genie © • Terms of Service • Privacy PolicyNameSubmit