GF Survey Personal DetailsName* First Last Date of Birth* MM slash DD slash YYYY 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 Primary Phone*Work PhoneEmail Address* Emergency Contact NameRelationship to youContact Phone NumberPrevious Volunteer Experience1. Company NameCompany ContactTelephone Number2. Company NameCompany ContactTelephone NumberAdditional Skills and AbilitiesPlease list any additional skills and abilities.Additional Skills and Abilities*AvailabilityPlease check the days/time of day you're available for work.Morning* Monday Tuesday Wednesday Thursday Friday Saturday Afternoon* Monday Tuesday Wednesday Thursday Friday Saturday Evening* Monday Tuesday Wednesday Thursday Friday Saturday Statement of Volunteer:I have chosen to volunteer with the Blood Bank of Alaska. If I do become a volunteer, I understand that I am not eligible for any wages or benefits and I will work in accordance with the volunteer policies and safety standards of the Blood Bank of Alaska. I agree to maintain the confidentiality of donors, staff and volunteer information. I further understand that the volunteer relationship is based on the mutual consent of each volunteer and the organization. Accordingly, either the Blood Bank of Alaska or I can terminate the relationship at will, at any time, with or without noticeCheckbox* Yes, I agree to the above statement and the information provided is correct to the best of my knowledge. Electronic Signature*Date MM slash DD slash YYYY
