VOLUNTEER APPLICATION FORM
       
Name
Father/Husband Name
Date of Birth
    Religion
Identity Card & Number (Any one)
ID Card Number  
Education Qualification
Name of College
Address of College
Are you associated with any other Voluntary Organization?
Eg NSS, NYKS, Yuwak Mandal, Red Cross etc.
Which volunteer institution you are associated?
If Yes, How long you are the volunteer with your institution?  Years   Months
Have you received any training on COVID-19 by your institution till now?
Name the volunteer association with which you are associated
Mobile/Telephone No 1:     Service Provider   
     Mobile/Telephone No 2:     Service Provider   
Whatsapp Number     Service Provider   
  Email Id:  
 
Communication Address
Address
Village
Block
District
 
Do you have any Medical/Health Problems?
Eg Hypertension, Diabetes, Heart Diseases, Kidney Diseases
Do you have any past illness in last six month due to which you have been admitted in hospital?
If Yes, What was the medical condition :-
Have you came in contact with CORONA positve patient in last 14 days?
If you are married female, Are you pregnant?
Do you have a Android Smart phone for your personal use?
Emergency Contact:
 
Name:-
Relation:-
Full Address:-
Mobile Number:-
 
Reference:
 
Name:-
Mobile Number:-
Occupation:-
 
  Declaration:
I hereby certify that the information provided above is correct to the best of my knowledge.
 
       
       
    10/07/2020  
    Date