Name ___________________________________________________________________

Street Address _____________________________________________________________

City ______________________________________State _______ Zip ________________

Telephone _______________________________________________________________

Email Address__________________________________________________________

Occupation _____________________________________________________________

Employer _______________________________________________________________

Street address ___________________________________________________________

City _____________________________________State ________ Zip ______________

Telephone ________________________________

Please check all applicable items which you have experience with and explain where you received this experience. If there is not enough space below please add an attachment.

(  ) Writing and Editing Newsletters             (  ) Layout of Newsletters and Flyers

(  ) Typing and Word-processing                 (   ) Public Relations

(  ) Library Science                                      (   ) Fundraising

(  ) Receptionist (answer phones, etc.)           (  ) Marketing 

(  ) Counseling                                             (   ) Other

Explain____________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Days Available ____________________________ Time Available ______________________

           ---------------------------------------------------------------------------------------------------
                                         Office Use Only

                 Date Contacted _________ Date Interviewed _________ Start Date _________