Volunteer Application Step 1 of 4 25% Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home PhoneCell PhoneWork PhoneEmail How would you prefer to be contacted?*Home PhoneCell PhoneWork PhoneEmailPostal Mail What position(s) are you interested in?* Greeter Basic Tax Preparer Advanced Tax Preparer Screener Basic Reviewer Advanced Reviewer Have you previously volunteered for VITA?YesNoDo you have previous tax preparation experience?YesNoPlease describe your previous experience:Do you have bilingual skills?YesNoWhat languages do you speak?Hours Available to Volunteer (check all that apply) Monday 12:30 - 3:30 p.m. Monday 3:30 - 6:30 p.m. Tuesday 5:00 - 8:00 p.m. Wednesday 12:30 - 3:30 p.m. Wednesday 3:30 - 6:30 p.m. Thursday 12:30 - 3:30 p.m. Thursday 3:30 - 6:30 p.m. Saturday 7:30 - 12:30 p.m. How many total hours would you like to volunteer for VITA?*Please enter a value between 1 and 100.NOTE: Volunteers are asked to commit to at least 20 hours of volunteer time at the VITA site for the entire tax season.How did you hear about VITA volunteer opportunities? (check all that apply) Employee of IRS/DOR School Goodwill NCW website VITA website Newspaper Other Please explain (name of employee, school, other source) Emergency Contact InformationName First Last Relationship to ContactPrimary PhoneSecondary Phone Background InformationDo any of your relatives work for Goodwill NCW?YesNoName(s)Have you ever been convicted of a crime?YesNoPlease explain nature of the crime, date and state of conviction?Section BreakMedical Consent By checking below, I authorize the sponsoring VITA agency to provide first aid to me as may be necessary. I also give my permission to be transported to a local hospital for necessary medical treatment.Medical Authorization* Yes Section BreakSignature & Acknowledgement By entering my full name in the space below, I am consenting to the above items, and confirming the accuracy of the information provided.Signature (First M. Last)*Date* This iframe contains the logic required to handle Ajax powered Gravity Forms.