If you are a human and are seeing this field, please leave it blank. Intern/Volunteer Online Application First Name Last Name Date of Birth Age Home Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Work Phone Home Phone Email Address Ethnicity ( please select only one option ) Hispanic or Latino Not Hispanic or Latino Race ( please select all that apply ) White Asian Black or African American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Religion List each city you have lived in during the past 5 years How long in Birmingham? Current Place of Employment Occupation How long with present company? Supervisor's Name Highest Completed Education Elementary High School College Military Service Details (if applicable) Branch, Rank, and how long did you serve or have you served? Marital Status Single Married Widowed Separated Divorced Remarried Since Date (if not single) Spouse's Name Spouse's Place of Employment Spouse's Age Select if your spouse is agreeable to you becoming a volunteer. Names and ages of children in your home Select if you are expecting any changes in your job, home or family in the coming year. Year and Make of your Car Insurance Company Policy Number Describe any court convictions, including moving traffic violations Describe any medical treatment you have had in the past 5 years. How did you learn about The Exchange Club CAP Center? Why do you want to be a volunteer? Do you belong to any unions or professional associations? (please name all) What helping organizations have you belonged to? Describe your type of personality in one word. Describe your experiences with children. How long can you commit yourself to this program? What dates and times can you work each week?