VOLUNTEER Questionnaire for Habitat  
                 Española Valley & Los Alamos, Inc.

Name __________________________________________________   Birth Date (optional)_______________
                            (Last)                                   (First)
Address _________________________________________________________________________________
                      (Street)                                                   (City)                           (State)          (Zip)
Telephone (H)______________________ (W)_______________________ (Cell)_______________________
Occupation _____________________________  Employer ________________________________________
Date____________    E-mail Address _________________________________________________________
Referred by _____________________ Best way to contact you (circle one): Telephone (home or work) / Email
Tetanus Shot _____ Yes _____ No    Approximate date of last shot _______________________    
Community of Faith (optional)____________________________________  

HABITAT ReSTORE OPPORTUNITIES (check areas of interest)  
____ Cashier (experienced/learner)                               ____Sales (in-store customer service, stocking)       
____ Office assistant (computer, prepare displays, event preparation)
____ Warehouse (prepare donations, unload truck)         ____ Pickup donations (need truck, heavy lifting)       
____ Other: (marketing, fund raising, computer, displays, special events, cleaning, ________________)                                                                                

HABITAT ReSTORE  SHIFTS AVAILABLE: 
Monday:      ___10 am–12 pm ___1 pm-3 pm     Tuesday:___10 am –12 pm ___ 1 pm - 3 pm
Wednesday:___10 am –12 pm ___ 1 pm - 3 pm     Thursday:___10 am –12 pm ___ 1 pm - 3 pm
Friday:        ___10 am –12 pm ___ 1 pm - 3 pm      Saturday:___10 am –12 pm ___ 1 pm - 3 pm

VOLUNTEER SKILL INVENTORY

Non-Professional ____    Bilingual ____    Cleaning ____   Facilities Assistance ____    Food Preparation

Computer Stuff ____    Computer             ____    Excel/Database             ____    Ms Word             ____    Power Point ____    Publisher ____    Accounting/CPA ____    Architect ____    Internet             ____    Windows             ____    Networking

Pro/Semi-Professional ____    Art/Design ____    Business Writing ____    Corporate Contacts ____    Fundraising ____    Grant Writing ____    Marketing ____    Material Soliciting ____    Newsletter ____    Personnel ____    Strategic Planning ____    Trade Shows ____    Video/Film