Online Application Form

Title (required)

Your Name (required)

If You Currently Are Employed – where do you work?

Company Name (required)

Job Title

Occupation

Address

City

State

ZIP

Phone (ex. 123-456-7890)

Email (required)

Do Not Call My Job 

Do you Need Community Service Hours? 

Your Home Mailing Address:

Address

City

State

ZIP

Phone (ex. 123-456-7890)

Email (required)

Do Not Call My Home 

Need Community Service Hours? 

Available to Volunteer:
Day:
Time:

Skills

Please list any other professional and/or volunteer positions currently or previously held:

May we contact any of these as a reference for you?
 Yes No
If Yes, phone (ex. 123-456-7890)

The following information is voluntary and is not used to decide where to place you to volunteer.

Date of Birth

Sex
 Male Female

Ethnicity
 Africa-American Anglo/White Asian Hispanic Native American Other

CONSENT and HOLD HARMLESS AGREEMENT:
I wish to volunteer my services to United Way of Greater Williamsburg and/or various community service organizations through the United Way of Greater Williamsburg Volunteer Center. I understand that the nature of the volunteer activities may involve physical activity, contact with unidentified and unfamiliar persons, travel to and from various unspecified locations, dealing with confidential information, and possibly the potential risk of personal and or property injury. Knowing this, I still wish to volunteer and hereby assume the risk with respect to any liability of the United Way of Greater Williamsburg for such risks, of any accident or injury to person or property which I may sustain in connection with my participation as a United Way volunteer or in any United Way related activity and hold the United Way of Greater Williamsburg harmless. In addition, I hereby release and discharge the United Way of Greater Williamsburg and any of its directors, officers, employees, partners, affiliates, agents and successors from any and all liability or responsibility for any such accident or injury or related occurrence.

Understanding that the United Way of Greater Williamsburg is involved in assisting organizations involved with child care and related matters, I hereby affirm that I have never been convicted of a violent crime, child abuse, child neglect, child pornography, child abduction, kidnapping, rape or any sexual offense. Lastly, I have never been ordered by a court to receive psychiatric or psychological treatment in connection therewith.

CONFIDENTIALITY AGREEMENT:
It is bad practice to disclose any confidential information about United Way of Greater Williamsburg’s volunteers, clients or organizations. Any breach of confidence is considered very serious and will result in the termination of the volunteer.