7451 Riviera Blvd..

, #112 • Miramar, Florida • 33023

Phone 305-491-6464
www.emaneulbenterprises.com

VOLUNTEER APPLICATION
Dr. Mr. Mrs. Ms. ______________________________________________ Phone # ___________________
(PLEASE CIRCLE ONE) (LAST NAME) (FIRST NAME) (M.I.) (AREA CODE)

Local Address
(COLLEGE STUDENTS, PLEASE INCLUDE BOX #) (STREET) (CITY) (STATE) (ZIP CODE)

E-mail Address:_____________________________________________________________________________
Social Security #: ___ ___ ___-___ ___-___ ___ ___ ___ Date of Birth: ___ ___/___ ___/___ ___
EDUCATION:
HS Grad. or Equivalent: ___Y ___ N Advanced Degrees or Professional Licenses:
CURRENT EMPLOYMENT:
Employer: Position:
Address: Phone: Fax:
(extension )

CURRENT STATUS:
Parent ( ) Student ( ) Retiree/Senior ( ) Employee Release: ( )
(SCHOOL YOUR CHILD ATTENDS)

LIST LANGUAGES OTHER THAN ENGLISH YOU ARE FLUENT IN: ____________________________

SKILLS/HOBBIES/INTERESTS:
TYPE OF VOLUNTEER ASSIGNMENT PREFERRED:
____Early Elementary Reading Tutor ____Middle School Reading/Writing Tutor
(GRADES K-2) (GRADES 6-8)

____Elementary Reading/Writing Tutor ____Middle School Math Tutor

(GRADES 3-5) (GRADES 6-8)

____Elementary Math Tutor ____Higher Level Math Tutor

(GRADES K-5) (GRADES 9-12)

Algebra I Algebra II Geometry Calculus Trigonometry

(CIRCLE THE MATH LEVELS YOU ARE ABLE TO TUTOR)

____Reading Program _____ General Tutor_____________________

(ONCE IN OCTOBER, NOVEMBER & DECEMBER) What Subject?

SCHOOL PREFERENCE:
SCHEDULE: (Indicate hours you are AVAILABLE to volunteer)
Monday Tuesday Wednesday Thursday Friday
8:00 - 9:00
9:00 - 10:00
10:00 -11:00
11:00 - 12:00
12:00 - 1:00
1:00 - 2:00
2:00 - 3:00
After School

Do you have transportation? Yes ( ) No ( ) (OVER)

REFERENCES: (Non-family members)

Name Address Telephone Position/Title

How did you hear about us? Website ( ) Newspaper ( ) Radio/TV ( ) School Volunteer ( ) Other _______

What is your reason for volunteering?

COLLEGE OR HIGH SCHOOL STUDENT VOLUNTEERS:

PLEASE COMPLETE THE FOLLOWING:

Freshman ( ) Sophomore ( ) Junior ( ) Senior ( ) Graduate Student ( ) Major:

Reason for volunteering:
Number of Hours Needed: Date to be completed:
School Name:
Title/Name of School Contact:

APPLICANT’S STATEMENT

• I certify and attest that the above-mentioned information is true and complete to the best of my
knowledge.

• I understand that if I am placed, any volunteer work will take place only at the assigned location.

Signature: Date:
Interviewer: Date:

OPTIONAL INFORMATION:
Emanuel B Enterprises LLC receives funds from many sources. We are often asked to provide statistics to
show that we have diversity among our staff and volunteers. Kindly provide us with the following
information so that you can accurately be reflected in those statistics. This information is completely
optional and voluntary.
Race/Ethnicity: ___Black ___White ___Hispanic ___Asian ___Native American ___Other
Gender: ____Male ____Female

It is the policy of Emanuel B. Enterprises LLC. not to discriminate on the basis of race, sex, religion,
age, national origin, handicap, color or veteran status. 08/23