Volunteer Application

Date

.

Name

Contact Information

Home Phone Other Phone

Email address Repeat email address

Position Desired

Option 1 ....... Option 2

.

Preferred Shift

8am - 4pm 4pm - 12am 12am - 8am

.

Are you employed now? Yes No -- Where?

May we contact your present employer Yes No

.

List any special qualifications and skills you may have in the position you are volunteering for

.

Personal Information

Social Security Number

Birth Date: Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day Year

Are You: Mr Ms Mrs ........... Birthplace

Mailing Address:

P.O. Box City State Zip

.

Village of residence .

Citizenship: American Samoa US Other Country

If you were not born in American Samoa and you are not a U.S. citizen; Has the Immigration Board granted you permanent residence in American Samoa? Yes No

Documents will be required in support of a "yes" answer.

What is your AR number:

.

Licenses and Certificates

State of Other Licensing Authority

Validation Dates

.

Education

What is the highest grade you have completed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

.

College or University Dates Attended Degree

College or University Dates Attended Degree

College or University Dates Attended Degree

Languages

Samoan
Speaking: Excellent Fair Poor - Writing: Excellent Fair Poor

English
Speaking: Excellent Fair Poor -- Writing: Excellent Fair Poor

Other Language

Speaking: Excellent Fair Poor -- Writing: Excellent Fair Poor

References: List three references we can contact for more information.

Reference Name Phone Business

Reference Name Phone Business

Reference Name Phone Business

Employment History: List your most recent employment.

Employer Title Held Dates Phone

Employer Title Held Dates Phone

Employer Title Held Dates Phone

We will contact you within one week for an interview. Please be prepared to bring your personal vitae and any other supporting documents with you to the interview.

I certify that all the statements made on this application are true, complete and correct to the best of my knowledge.

Certify

The board of Directors of the 10th Restival of Pacific Arts is authorized to verify my credentials and/or employment as listed in this application.

Agree