Date of Application
General Information
Full Name
Full Address
Interest in the SHIP program
Highest level of education completed:
Do you speak any languages other than English?
SHIP volunteers cannot work for insurance companies, have an insurance license and/or sell insurance for at least one year prior to volunteering. A person cannot potentially receive any financial gain from becoming a SHIP volunteer counselor.
Are you currently working in the insurance industry?
If no, have you in the past 12 months?
Do you require any special accommodations?
Employment/Volunteer History
Please tell us about your most recent/relevant work experience, including paid and volunteer positions.
Dates of Employment:- From
Dates of Employment:- To
Date of Employment From
Dates of Employment To
Commitment Terms
SHIP Volunteer Program requires a minimum of 100 hours of volunteer service in a calendar year.
2) Please click on your availability: (Hours are flexible upon request)
References
All applicants must submit at least two references. Please provide complete information for professional references (not relatives) that have known you for a minimum of one year.
Reference 1:
Reference 2:
Insurance/Liability
I understand that as a volunteer I am afforded liability protection with respect to damages to third parties to the same extent as the District of Columbia employees, as long as I am acting within the scope of my duties as a volunteer. I understand that there are inherent dangers in any workplace activity or program. District of Columbia assumes no liability for injury to myself or damage to my personal property unless caused by the negligence of the District of Columbia. I hereby release and hold harmless District of Columbia, its officials, agents and employees from liability or obligation arising from, or in connection with my volunteer activities.
Insurance/Liability Acknowledgement
Authorization and Certification
I certify that the information I provided in this application is true, complete, and accurate to the best of my knowledge. I also authorize the SHIP program to contact the references named with regard to my application to become a SHIP Volunteer. I also authorize the persons referenced to provide information in connection with my application, and release them from any liability in regard to it.
Authorization and Certification Acknowledgement