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Any special talents or skills you have that you feel would benefit the organization?*

Please indicate days you are available to volunteer.* SundayMondayTuesdayWednesdayThursdayFridaySaturday

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KHDS completes references for all new hires, interns, and volunteers. Please provide three references.

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Years Known:*

Reference 2. Name:*

Email Address:*

Phone #:*

Relationship:*

Years Known:*

Reference 3. Name:*

Email Address:*

Phone #:*

Relationship:*

Years Known:*

KHDS completes criminal background checks for all potential hires, interns, and volunteers. Is there anything on your background check that might come up that could hinder us from moving forward? YesNoI'm unsure.

Are you applying to volunteer with the Narcotics Anonymous (NA) group?* YesNo

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To comply with government Equal Employment Opportunity and/or Affirmative Action reporting regulations, we are requesting (but NOT requiring) that you enter this personal data. This information will not be used in connection with any employment decisions, and will be used solely as permitted by state and federal law. Your voluntary cooperation would be appreciated. Learn more.

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