Application to Volunteer Volunteer/Shelter Locations: Our Cat Shelter is located in East Hartford We have two Dog shelter locations: East Hampton & Wethersfield Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Current School or Employer Job Title How did you hear about POA?*POA VolunteerPOA SupporterPOA EventSocial MediaTelevisionRadioOtherIf Other, how did you learn about POA? Have you previously been a POA volunteer?* Yes No If Yes, when did you last volunteer and what was your reason for leaving? Are you currently employed?*Full-TimePart-TimeUnemployedStudentRetiredAre you available for the same day/time each week?* Yes No What Days/Times are you Available?* Are you able to volunteer for at least 3 consecutive months? (Required)* Yes No Are you 18 or older?* Yes No Do you have current health insurance? (Required for all volunteer positions)* Yes No Do you have reliable transportation?* Yes No Please be advised that a background check may be conducted before approving this application. For any questions, please contact 860-569-0722Have you ever been convicted of animal abuse?* Yes No Are you volunteering to meet community service requirements?* Yes No Why do you want to volunteer with POA? What do hope to get from the experience?*Have you ever adopted from POA* Yes No What animal-related experience do you have? Check all that apply. Veterinary Hospital/Vet Tech/Vet Asst Boarding Facility Foster Home Cat Grooming Dog Grooming Animal Shelter/Rescue Pet Sitting Dog Walking Training/Obedience Other If other, please explain here: If you would like to detail any of you animal-related experience, please do so here:Other skills, abilities, talents. Please check all that apply. Computer Skills Graphic Arts Writing Photography Fund-Raising Event Planning Public Speaking Marketing Management Painting Carpentry Other If other, please explain here: If you would like to detail any of your skills, please do so here:List any other animal welfare organizations that you have worked with.Are you able to meet the Essential Volunteer Capabilities?*Without AccommodationsWith AccommodationsIf with accommodations, what accommodations would you need?Would you prefer to work with cats or dogs?*CatsDogsCats or DogsOffsite - Humane Education or OtherOtherIf other, please explain here: What type of volunteer work interests you most:*Hands On with CatsHands On with DogsClericalEventsFund-RaisingOtherIf other, please explain here: I verify that all the information I have provided in this application is true and accurate.* Yes No
