POA Volunteer Application

First Name *
Last Name *
Do you have current health insurance? (Required for all volunteers) *
You must have current health insurance to be able to volunteer. For any questions, please contact 860-569-0722.
Street Address *
City *
State *
Zip *
Phone 1 *
Phone 2
Preferred day/time for a phone call? *
Email Address *
Gender *
Highest Education Level *
Occupation *
Employer
Have you adopted a pet from POA? If Yes, when?
Are you at least 18 years old? (Minimum age to volunteer in direct contact with animal is 18 yr) *
Have you been convicted of a crime in the past 7 years? If Yes, please explain. *
Please be advised that a background check may be conducted before approving this application. For any questions, please contact 860-569-0722.
Which of our volunteer positions are you applying for? (You can select more than one) *
What days & times of the week are you available to volunteer? *
How many hours a week would you like to work? *	1-2hrs 2-4hrs 4-8hrs >8hrs
Are you able to commit to at least 6 months of volunteering after starting?
Are you volunteering to meet mandatory community service requirements? *
Do you have any physical, medical, or psychological limitations or disabilities that might keep you from participating in any area of the volunteer program (e.g., heart condition, back injury, etc.)? *
Provide 2 personal (non-family)references: (Name, Phone, email) *
Emergency contact: Name, Phone Number, Relationship *
List any organizations and animal rights groups you have belonged to in the last 5 years.
Why do you want to volunteer for POA?
Have you ever done any volunteer work? If yes, please tell us where, when and describe duties.

Thank you for your interest in volunteering for POA. We receive a high volume of applications every week. Please allow us up to one week to review your application. Thank you in advance for your cooperation. If you have any further questions please call at 860-569-0722