General Information :

How did you hear about volunteer opportunities at the American Lung Association of Hawaii? :
Why are you interested in volunteering? :
	Have you volunteered with ALA before? :	Yes No
If yes, where, when and what was your assignment? :
Please check skills you would like to share with ALAH :
	Typing :
	Word Processing :
	Data Entry :
	Marketing :
	Fund Raising :
	Internet :
	Public Relations :
	Special Events :
	Finance :
	Medical Expertise :
Other skills :
	Have you ever been convicted of a felony? :	Yes No
If yes, please explain :

References :

Reference #1 Title :	--- Mr. Mrs. Mr. & Mrs. Ms.
Name :
Phone :
Island :
What is your relationship to this person? :
How many years have you know him/her? :
Reference #2 Title :	--- Mr. Mrs. Mr. & Mrs. Ms.
Name :
Phone :
Island :
What is your relationship to this person? :
How many years have you know him/her? :

In Case of Emgergency, Please Contact :

Title :	--- Mr. Mrs. Mr. & Mrs. Ms.
Name :
Day Phone :
Night Phone :

Please Read This Statement, Then Agree Below If You Agree : I certify that the information contained in this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation or omission of fact in this application will be cause for refusal or termination from the Association. I authorize the Association to run the appropriate background checks required for this position.

I Agree :
Date :
Parent/Guardian (if applicable) I Agree :
Parent/Guardian Name :
Date :