The Cambodian Family
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Volunteer

Volunteer
Address
City
State/Province
Zip/Postal
Country

Monday

Tuesday

Wednesday

Wednesday

Thursday

Friday

Saturday

Program Interest

Emergency Contact

Skills and Interest

Education

highest grade completed

References

List two personal references, other than family members (must include e-mail or phone):
First Reference
Second Reference
(Conviction will not automatically bar you from volunteering. Relevance to assignment will be considered). *You may have to obtain a Live Scan fingerprinting performed as part of your volunteer work. The charge at Live Scan centers range from $20-$30.

I understand that I am not an employee of The Cambodian Family, and that any duties that I perform are as
a volunteer. I agree to abide by the procedures set forth by The Cambodian Family for my assigned work
duties. I also understand that it is my responsibility to update any address, emergency or other changes to
the information on this form.

By initialing, dating and accepting to above terms, I authorize The Cambodian Family to conduct a background check of my driving record
and my criminal record.

The Cambodian Family
1626 E. Fourth St. Santa Ana, CA 92701 | P: 714-571-1966

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