Volunteer App Step 1 of 2 50% Name* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone/Cell*Work PhoneArea of InterestWhich Department are you interested in?*Wood MillRecycleUpcycle StoreDSAWood ShopParticipant ServicesCorporate OfficeAnyWhy Do You Want To Volunteer at REACH?*Is there a person at REACH that you consider to be a personal contact?* Yes No What is the contacts name?* First Last Contacts Phone Number*Have you ever worked as a volunteer before?* Yes No List where you previously volunteered at*Organization NameYears volunteeredAddressPhone #Supervisor Name ReferencesPlease provide the following information for three people or more who are over 18 years of age, not related to you and are able to provide a reference supporting your integrity, Character, and personal commitment.*NameYears knownAddressPhone #Relationship Have you ever been convicted of a crime other than a minor traffic violation?* Yes No Please Explain (nature of crime, date, sentence, Rehabilitation)*Do you have any criminal charges pending against you?* Yes No Please Explain (nature of crime, date, sentence, Rehabilitation)*PLEASE READConsent* REACH Inc. is a 501(c3) nonprofit agency that does contract services for the Oregon Department of Human Services and therefore is responsible to live up to Oregon Regulations governing the handling of affairs for people who are considered Vulnerable Populations. REACH Inc. takes that responsibility very seriously and would like you to know that if you are selected to be a volunteer at REACH you will be required to live up to these requirements as well. Some of these things are: 1. You Will Be Required To Pass a Background Check a minimum of every 2 years. 2. You will be Required To Pass a Pre Employment Drug and Alcohol Screening (Including Marijuana) 3. You, Will, be Required to Pass any Random Drug and Alcohol testing asked of you by REACH Inc. The information contained in this application is correct to the best of my knowledge. I authorize any references listed on the application to give any information (including opinions) that they may be regarding my character and fitness for work with REACH participants. I release all such references from any liability for furnishing such evaluations to you, providing they do so in good faith and without malice. I understand this is not an application for employment. I further understand the REACH Inc. takes abuse very seriously and abuse in any form will not be tolerated. I am aware that my participation in abuse in any form is cause for removal from volunteer Services. I agreeCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
