Junior Board Application

Name(Required)

First Last

Primary Phone(Required)

Alternative Phone

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Highest Level of Education Attained:(Required)

Are you currently employed?(Required)

Yes

No

Employment

Current Employer(Required)

Position/Title(Required)

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone(Required)

Special training, skills, hobbies(Required)

Please list each on a separate line

Groups, clubs, organizational memberships, community involvement(Required)

Please list each on a separate line or put N/A

Please describe any previous volunteer experience(Required)

Please list each on a separate line and include the organization names and dates of service

What experiences have you had that you feel have prepared you to serve as a member of Community Grief Support's Junior Board?(Required)

How do you hear about Community Grief Support?(Required)

Do you have reliable transportation?(Required)

Yes

No

Are you willing to help coordinate and volunteer at events?(Required)

Yes

No

Can you attend bi-monthly meetings?(Required)

Yes

No

Please list 2 to 3 people who know you well and can attest to your character, skills, and dependability.(Required)

We suggest listing your current or previous employer for one of your references.

Name/Organization

Relationship to You

Length of Relationship

Phone Number

Commitment Statement(Required)

Please read carefully before checking the box below:

l understand that this is an application for and not a commitment or promise of membership to Community Grief Support's Junior Board. I certify that I have and will provide information throughout the selection process, including on this application and in any interviews with Community Grief Support that is true, correct and complete to the best of my knowledge. I understand that information contained on my application may be verified by Community Grief Support.

I agree to the Commitment Statement.

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Employment

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