Potential Volunteer

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Executive Service Corps of Chicago
25 East Washington St. Suite 1500
Chicago, Illinois 60602
312.580.1840
info@esc-chicago.org

Thank you for your interest in Executive Service Corps of Chicago. Please complete this form so that we may contact you. The only required fields are indicated with an *.

Please provide the following contact information:

 

Name*
Spouse/Partner Name
Street Address
City, State, Zip
Phone*
E-mail*
Fax
Birthday

ESC Volunteers Moushumi Majumder and Jan Rector discuss the client speaker at one of ESC’s Regional Meetings

Employment History

Current Status:  Retired   Partially Retired   (if partially retired please explain)

Primary Employment:  Company/Organization: 
  Title: 
  Function/Major Responsibilities: 
  From:
  To:    
Other Employment:

 
Principle industry within which you worked (please check)  
Accounting Banking/Financial Construction Education
Government Insurance Legal Manufacturing
Marketing/PR/Advertising Media Medical/Health Nonprofit
Real Estate Retail Technology Transportation
Utilities Other
Primary functional specialty (e.g. marketing, finance)

Nonprofit Volunteer Experience

Please list any organizations you have volunteered for, indicate whether it is a current or past affiliation, what your primary activities were/are and indicate if you were/are a board member.

Business/Trade Associations/Corporate Boards

Please indicate any organizations to which you belong or have belonged to in the past.

Background information

Are you available now for assignment to ESC projects?  Yes   No

Dates generally unavailable for assignment (one month or longer) 

Are you restricted to travel by public transportation? Yes   No

Name of local paper for press release 

Please describe any specific interest or question:

 

Referral Source:

Web Site

Employer

ESC Volunteer

Client Referral

Media-Radio/TV

Media-Print

 

Direct Mail

ESC Meeting

Seminar/Workshop

Foundation

SCORE

Other 

 

This form also may be printed and mailed to Executive Service Corps of Chicago, 25 East Washington Street, Suite 1500, Chicago, Illinois 60602, or faxed to (312) 580-0042. You may also telephone us at (312) 580-1840, EXT. 316 for more information.

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