Community Service Please Note once you submit this application you should here from a RVHR staff member within 48 hours. If you do not please call us at 540-525-1251 First Name:* Last Name:* Phone:* Area Code - Phone Number Cell Phone # Do you have texting on your cell?YesNo E-mail:* Address:* Street Address City State / Province / Region Postal / Zip Code Date of Birth:* How did you hear about RVHR? Days You are Available to volunteer:*SundayMondayTuesdayWednesdayThursdayFridaySaturday Hours you are Available to volunteer:*9am to 11am11am to 1pm1pm to 5pmother How often do you think you will be volunteering?*1 day a week2 days a week3 days a week1 -2 days month2-4 times monthNot sure What is your first available date you can schedule to come?* What is your second available date you can schedule to come? Have you ever been convicted of a felony?*YesNo If Yes Please Explian... Have you ever been convicted of a sexual offense?*YesN0 If Yes Please Explian..... Have you ever been convicted of animal Cruelty or neglect?*YesN0 If Yes Please Explain...... Are you filling out this form for Court Appointed Community Service Hours and/or School Community Service Hours?YesNo If Yes which county or school..... Number of Hours needed. When do you have to have your hours done? Are you employed at this time?*YesN0 If Yes with whom? Your Emergency Contacts Name:*FirstLast Emergency Contacts Phone:* Area Code - Phone Number Relationship to you? Do you have any medical limitations or do you take any prescription medications?*YesNo If Yes Please Explian What Electronic Signature* Date Submitted:Please note if you are using a gmail account for email Gmail will send our replies to your junk box. Please check that box for our replies. Thank you.Send Form To RVHRClear Form
