2. (The Loudoun Workforce Resource Center is part of the Dept. of Family Services)
   The Loudoun Workforce Resource Center requests the following information to assist in determining if your skills, availability and experience are a good match with the services offered and our needs. This information is confidential and for internal use only. Thank you for your time in completing this application, which serves as the first step in the volunteer intake process.
4. Please read carefully before completing this online application
   All applicants interested in a Volunteer Trainer position must have a minimum of two years’ experience in the subject area they wish to teach and verifiable presentation and/or facilitation skills to groups of adults. To be fully considered for such positions, the minimum requirements must be reflected on the applicant’s resume and attached to the volunteer application at the time of submission.
6. Contact Information
8. First Name*
9. Last Name*
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Contact Phone Number*
21. Email Address
23. Availability
25. When are you available?*

    1. Weekday Mornings
    2. Weekday Afternoons
    3. Year-long

    1. Quarterly
    2. Monthly

    1. Weekly
    2. One-time Event
27. Present Employment Status:*

    1. Employed

    1. Self-employed

    1. Retired

    1. Unemployed
29. Do you have prior volunteer experience?*

    1. Yes

    1. No
30. If yes, please explain:
32. I am interested in volunteering for the Mouse & Keyboard Class Assistant

    1. Yes
    2. No
34. If you would like to attach your resume, please use the browse button below:
38. Background
40. Are you 18 or older?*

    1. Yes

    1. No
42. References:
    A reference should be a person (NON-RELATIVE) who is familiar with your qualifications and/or experiences as they relate to the topics you are interested in facilitating. YOU MUST PROVIDE TWO (2) REFERENCES.
44. Reference 1:
46. Name:*
47. Title:
49. Relationship:*
50. Years Known*
52. Daytime Phone*
53. Email
55. Reference 2:
57. Name:*
58. Title:
60. Relationship:*
61. Years Known*
63. Daytime Phone:*
64. Email:
66. Consent to Release Information/Disclosure
68. I hereby authorize the Loudoun Workforce Resource Center (part of the Department of Family Services) to verify information reported on this application. I understand that this information may be gathered at anytime during my association as a volunteer with the Loudoun Workforce Resource Center. I release the Loudoun Workforce Resource Center and organizations supplying information, from all liability and responsibility, damages and claims of any kind arising from this investigation of my background.
    
    I understand that misrepresentations or omissions may be cause for my immediate denial as an applicant for a volunteer position or my termination as a volunteer with the Loudoun Workforce Resource Center.
    
    I understand that this is an application for and not commitment or promise of volunteer opportunity.
    
    I understand that all information will be considered confidential to the fullest extent allowed by the law.
70. 1. I agree to the above statements
71. Please enter your initials
73. Just a reminder: Once the application is received, the Training Coordinator will contact the prospective volunteer to ask questions, gather more information and possibly schedule an interview.
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field