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 Name Relationship to you Contact Phone NumberPrevious Volunteer Experience1. Company Name Company Contact Telephone Number2. Company Name Company Contact Telephone 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
