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2. Hoke County Emergency Volunteer Application
4. Personal Information
6. First Name*
7. Last Name*
9. Address*
11. Date Of Birth*
12. Home Phone*
13. SSN*
15. Email Address*
17. Do You Have a Valid Drivers License?

    1. Yes
    2. No
18. Drivers License Number
19. Vehicle License Plate Number
21. Insurance Company
22. Policy Number
24. Have You Ever Been Convicted For Violations Of Any Laws, Traffic or Otherwise?*

    1. Yes
    2. No
26. If Yes, Please Explain:
28. Do You Have Any Physical Condition That May Limit Your Activities? If Yes, Please Explain.
30. Who Should We Contact In Case Of An Emergency? Please Include Name And Phone Number.*
32. Availability and Volunteer Preferences
34. Please State What Volunteer Services You Are Willing To Provide?*
36. Please Check All That Are Applicable:
38. I am Available...*

    1. Mornings Monday through Friday
    2. Afternoons Monday through Friday
    3. Evenings Monday through Friday
    4. Weekends
    5. Once a Week

    1. More Than Once a Week
    2. One Time Only
    3. As Needed
    4. Other
40. I Hereby Give My Consent For Hoke County Local Government To Conduct A Background Check.*
    Please Type Legal Name As Signature.
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field