Volunteer Name(Required) First Last Date(Required) MM slash DD slash YYYY Address(Required) 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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Have you had previous involvement with Full Circle? Y/N. If yes, in what capacity?How did you hear about Full Circle Foundation?(Required) Social Media Website Word of Mouth In what program(s) do you wish to be involved?(Required) Upscale Resale Shop Edible Garden Internet Sales TEAM 26 Micro Enterprise Services Community Campus Classrooms Other Are you CPR certified?(Required) Yes No Are you trained in First Aid?(Required) Yes No What skills do you possess that would be of benefit to our organization’s mission?List 3 personal references. They must be over 18 and not related to you: Name(Required) Relationship(Required) Phone(Required)Name(Required) Relationship(Required) Phone Number(Required)Name(Required) Relationship(Required) Phone Number(Required)Driver’s License #(Required)Expiration Date(Required) MM slash DD slash YYYY Have you ever been convicted of a felony offense excluding minor traffic violations? Y/N If yes, please explain:I understand that by serving as a volunteer, I am not entitled to nor am I going to receive any type of monetary compensation for my work. I release the Full Circle Foundation from any and all liability in the course of my volunteerism except in cases of gross negligence or intentional misconduct. The information contained in this application is correct to the best of my knowledge. I authorize any references, which are listed in this application to give you any information they may have regarding my character and fitness for working with this organization. I also authorize the Full Circle Foundation to conduct a background check with the necessary authorities to verify my fitness to serve. I authorize the Full Circle Foundation to make audio and/or video recordings of the program activities, and I give permission for the Full Circle Foundation to record my picture and voice on photographs, films, and tapes, without payment, and to incorporate these recordings into public relations and advertising materials and to use in any manner of media whatsoever. I understand that the personal information in this application will be held confidential by the Full Circle Foundation staff. The information contained in this application is correct to the best of my knowledge. I authorize any references, which are listed in this application to give you any information they may have regarding my character and fitness for working with this organization. I also authorize the Full Circle Foundation to conduct a background check with the necessary authorities to verify my fitness to serve. I authorize the Full Circle Foundation to make audio and/or video recordings of the program activities, and I give permission for the Full Circle Foundation to record my picture and voice on photographs, films, and tapes, without payment, and to incorporate these recordings into public relations and advertising materials and to use in any manner of media whatsoever. I understand that the personal information in this application will be held confidential by the Full Circle Foundation staff. SignatureDate(Required) MM slash DD slash YYYY If a Minor, Parent or Guardian SignatureDate(Required) MM slash DD slash YYYY CAPTCHA
