Brook Lane - A Continuum of Mental Health Services

Scoops and Wickets

The Wicket Affair

April 28, 2008 - May 29, 2008
Brook Lane’s Spring Community Calendar

Employees of the Month for 2008

January 23, 2008 - May 31, 2008
Laurel Hall School in Frederick is Now Open

Volunteer Application

To Applicant: We appreciate your interest in our organization and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the volunteer position that best meets your qualifications.

Personal

First Name:
Middle Initial:
Last Name:
Present Address:
City:
State:
Zip:
Home Telephone:
Work Telephone:
Cell Phone:
Email:

Sex : Male Female

Age (if under 18):

Why are you interested in becoming a volunteer at Brook Lane?

How did you learn about the Brook Lane Volunteer Program?

General Information and Volunteer Availability Please check the area(s) you would like to work:

Tutoring	Interpreting
Arts/Crafts	Classroom/Library Assistant
Gardening	Fundraising
Clerical Duties	Event Organization

Please list available hours.

	Morning	Afternoon	Evening

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Special Skills / Hobbies:

Education

Education Completed: grade school high school college other
If Other:

Employment History (past employment, internships and/or volunteer experience)

Company
Address:
City:
State:
Zip:
Telephone:

Dates employed:

Describe the work you did:

Type (Employment, Internship or Volunteering):

Company
Address:
City:
State:
Zip:
Telephone:

Dates employed:

Describe the work you did:

Type (Employment, Internship or Volunteering):

Company
Address:
City:
State:
Zip:
Telephone:

Dates employed:

Describe the work you did:

Type (Employment, Internship or Volunteering):

May we contact the employers above? YesNo

If not, indicate which one(s) you do not wish us to contact?

References (Please do not use relatives)

Name:
Address:
City:
State:
Zip:
Telephone:
Email:

Name:
Address:
City:
State:
Zip:
Telephone:
Email:

Name:
Address:
City:
State:
Zip:
Telephone:
Email:

Please read below:

We appreciate your interest in volunteering with Brook Lane.

I give permission to Brook Lane to investigate any and all information concerning my application in order to determine my qualifications. This includes, but is not limited to TB testing, criminal background, employment, and personal reference checks. I understand any misrepresentation of facts contained in this application may be cause for my rejection or dismissal.
I agree to be photographed by Brook Lane.
I agree to abide by all Brook Lane policies and regulations. I understand that this application and any other such documents are not contracts of employment, and that any volunteer who is placed may voluntarily leave, and/or may be dismissed by Brook Lane at any time for any reason.
In the event of resignation or dismissal, I agree to return all Brook Lane property loaned to me.

My signature or typing of my name on electronic application indicates that I have read, understood, and consented to the above statements. This authorization or photocopy shall serve as consent for Brook Lane to request any information concerning my application.

I have read and agree to the terms above

Name: Date:

1-800-342-2992
(301) 733-0330
FAX (301) 733-4038

13218 Brook Lane Drive
P.O. Box 1945, Hagerstown, MD 21742


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