Prospective Community Blood Center Volunteer Profile

General Information

*First Name

*Last Name

Nickname

*Street Address

*City

 *State
MO KS

*Zip Code

Home Phone

Cell Phone

Work Phone

Email

Birthday (mm/dd)

*Emergency Contact
  Name

*Relationship

*Phone

Please help us learn more about you. Mark item which best describes you.

Student: Name of School     

Employed: Employer/Occupation

Retired: Former Employer/Occupation

Other:

Please check boxes with your preferences:

I prefer to work in the donor area supporting blood donors and other customers

I prefer to work behind the scenes; for example in an office, clerical area, warehouse or facilities management

I prefer to drive and transport blood products

I am willing to volunteer wherever the greatest need

Please check the boxes of the days/times you are most often available to volunteer:

Morning:
Sunday  Monday  Tuesday  Wednesday  Thursday  Friday  Saturday

Afternoon:
Sunday  Monday  Tuesday  Wednesday  Thursday  Friday  Saturday

Evening:
Sunday  Monday  Tuesday  Wednesday  Thursday  Friday  Saturday

How frequently would you like to volunteer?

2 times a week       1 time a week      2 times a month      1 time a month

Additional preference or availability information:

Volunteer experience: List any special skills, hobbies and things you like to do:

Do you speak, read, or write any foreign language?

Yes       No       If yes, which language(s)

How did you learn about Community Blood Center Volunteer Program?

Are you currently a blood or apheresis donor?   

Yes       No

Are you required to volunteer?

Yes       No       If yes, by whom:

Please provide the names and contact information for two unrelated personal or professional references.

Name:

Relationship:

Phone:

Address:

Email Address:

Name:

Relationship:

Phone:

Address:

Email Address:

I have carefully and truthfully completed this volunteer application. Falsification of information can disqualify me from consideration for volunteer service. I hereby give my permission and authorize representatives of Community Blood Center to verify information as necessary. A criminal background check will be performed prior to applicable volunteer assignments. I understand this profile does not guarantee a volunteer placement at Community Blood Center.

If applicant is under 18 years of age please print, fill out, and fax the Volunteer Parental Consent Form to 816-968-4430