North Carolina 4-H Volunteer Application Form

Name:

Mailing Address

How long have you lived at this address? (years)

NC ID #

State Driver's License #

Social Security #

Occupation

Sex: Male Female

Phone #: Day ____________________ Best time to call____________
Evening__________________ Best time to call____________

Are you a 4-H Alumnus? ________ If so, where? _________________

Have you ever been a 4-H Leader? ___Yes ___NO
Where___________________________

Why are you ointerested in a 4-H volunteer position?

Do you prefer to work with:

  1. Youth______
  2. Adults_____
  3. Both_____

What age levels do you like best?

  1. Ages 5-8 ______
  2. Ages 9-12_____
  3. Ages 13-19_____
  4. No preference_____

What time commitments are you considering? _____hr./week _____hr./month

Previous work or volunteer experience (list Employer or organization, the number of years as a volunteer and the postition you held. Begin with you most recent experience)

______________________________________________________________

______________________________________________________________

______________________________________________________________

Skills, training, education, hobbies:

______________________________________________________________

______________________________________________________________

______________________________________________________________

Please check one or more leadership roles you are interested in:

  1. ___Leading a club
  2. ___Teaching adults
  3. ___Teaching youth
  4. ___Making Displays
  5. ___Serving on committees
  6. ___Organizing events and activities
  7. ___Writing news articles
  8. ___Chaperoning overnight trips
  9. ___Coaching youth on presentations

Presonal References: Please list 2, with complete addresses and phone #.
_________________________________________________________________ _________________________________________________________________

Have you ever been convicted of a felong? ___Yes ___No

If yes, please give date, nature and sisposition of offense. _________________________________________________________________ ___________________ _________________________________________________________________ ___________________ _________________________________________________________________ ___________________

Please note: A criminal record will not necessarily prevent an applicant from being a 4-H volunteer, but rather will be consiteder as it relates to specifics of the volunteer position for which you are applying.

References: List two personss, not related to you, who have knowledge of your qualifications. Please provide complete addresses and phone numbers.
_________________________________________________________________ _________________________________________________________________

Applicant's Signature_______________________________Date__________

Please return the appplication at your earliest convenience to:

Sampson County 4-H
Att: Ms. Dixie Jordan 369 Rowan Rd
Clinton, NC 28328

For further information contact by phone at (910)592-7161 or E-mail
DeLeon_Wilks@ces.ncsu.e du
or Dixie_Jordan@ncsu.e du

Employment and Program Opportunities are offered to all people regardless of race, color, national origin, sex, age, or disability. North Carolina State University, North Carolina A & T University, U.S. Department of Agriculture, and local governments cooperating.

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