Volunteer Guardianship Application "*" indicates required fields GENERAL INFORMATIONName* First Maiden Name or NicknameDate of Birth* MM slash DD slash YYYY Email* Home PhoneCell PhoneBusiness PhoneADDRESSAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Length of time at current residence:*Marital Status*Spouse's NameWhat is the highest level of education that you completed?*Tell us about any degrees, certificates or continuing education you have that might be helpful for a guardian.*Do you speak a foreign language?* Yes No Can you communicate using sign language?* Yes No What do you enjoy doing in your free time?*CURRENT EMPLOYMENTEmployer*Phone*Employed From:* MM slash DD slash YYYY Employed To: MM slash DD slash YYYY ADDRESSAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What kind of work do you do? Tell us about your current job.*Have you ever been fired, terminated, or disciplined from employment?* Yes No PERSONAL REFERENCEPlease provide us with a reference (over the age of 18 years old). The reference should be business, professional, or clergy (non-family members, please). Please notify your reference so that the person will expect our communication with them.Reference*NameRelationshipPhoneAddress Add RemoveVOLUNTEER EXPERIENCEHave you ever been appointed as guardian in the past for anyone?* Yes No Why are you interested in volunteering to become a guardian in our program?*Please list any professional, personal, and/or volunteer experiences working with the elderly, the mentally ill, or the mentally disabled:*How did you hear about the Volunteer Guardianship Program?*
