North Carolina Aquarium at Pine Knoll Shores
Volunteer Dive Program Application

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
Mobile Phone
E-mail
Emergency Contact
Phone Number
Spouse's Name (for membership purposes)

Please identify and describe yourself:

Date of Birth
Sex	Male Female
Highest level of education completed
Graduated	Yes No
Degree/Diploma (if applicable)
Major
Other training or certification

Work Experience:

Occupation (If retired, give most recent paid employment)
Current Employer / Position
Are you a Student?	Yes No
Institution

Diver Certification and Experience:

Highest level of recreational certification
Date of Certification
Number of logged dives
Date of last dive

Volunteer Availability:

List ALL day(s) of the week you are available to volunteer
List the day(s) of the week you prefer to volunteer

 IMPORTANT: You must pass a NC Aquarium dive physical before participating in this program.  The required commitment for this program is one full day (9 AM - 4  PM) once every two weeks, for a minimum of one year.

Volunteer Experience:

Organization and dates of volunteering
Responsibilities

Have you ever been convicted of an offense against the law other than a minor traffic violation: Yes  No
If yes, please explain:

References:  All references should be professional, academic or community, and someone who is not related to you or living with you.

Name
Address
Phone
Relationship

Name
Address
Phone
Relationship

Acknowledgment:

I certify that the statements made in this volunteer application are true and correct, and I have not knowingly withheld any information. If the information provided in this document is found to be untruthful, I understand that I will be released from the volunteer program. I authorize verification of all information contained in this application and grant permission for references to be contacted.

I understand that I will not be paid for my services as a volunteer, and that filling out an application for the program does not guarantee acceptance into a volunteer position.

I understand that as a volunteer at the North Carolina Aquarium, I will be expected to demonstrate a serious commitment to uphold the mission of the Aquarium, to maintain an environment of integrity for people and the animals, and to focus on customer service, with respect for all employees, volunteers and guests. I agree to follow all Aquarium guidelines and policies.

By submitting this form you are electronically signing and verifying all information to be true.

North Carolina government policy prohibits discrimination based on race, sex, color, creed, national origin, age or disability.



* Upon receipt of this on-line application, an e-mail reply will be sent to you.