| Last Name: |
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| First Name: |
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| Email: |
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| Sex: |
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| Date of Birth: |
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| Place of Birth: |
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| Nationality: |
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| Passport Number: |
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| Profession: |
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| Do you have a promotion code? Enter here (optional): |
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| Destination: |
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| Project: |
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| Expected Arrival Date: |
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| Expected Departure Date: |
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| Quest duration: |
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| Are you in school? |
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Please describe your educational background and any relevant work experience :
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Please include any languages that you speak and how
fluent you are at speaking this language:
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Please describe your strengths and weaknesses, interests and hobbies, and any volunteer experience or intercultural experience you have had:
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Would you be willing to talk with future Quest volunteers upon your return to share your experiences or take part in other United Planet activities and programs?
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Preferred method of communication:
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Do you have any objections to sharing a room?
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| Do you smoke? |
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| Do you have any special dietary requirements? |
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| Do you have any allergies? |
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| How did you hear about us? |
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Please specify how you heard about United Planet. Be specific if possible.
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Please list 1-3 names of local and/or community newspapers in your hometown.
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Contact person in case of emergency (name, address, telephone, e-mail)
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Beneficiary for Travel insurance (name, address, telephone, e-mail).
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Please let us know the name and email of the person who introduced you to the Quest program. (optional)
(Each
person providing a referral will receive a 10% discount on the Quest program) |
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| What is your T-shirt size? |
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Have you been convicted of a felony?
Within the past five (5) years have you been convicted of, or completed a period of incarceration for, a misdemeanor which was not a first conviction for drunkenness, simple assault, speeding, a minor traffic violation, an affray, or disturbing the peace?
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Please Note:
1. Conviction of a crime or a guilty plea to a criminal charge will not necessarily disqualify an applicant. United Planet will consider the gravity of the offense, the time passed since conviction or plea and the nature of the volunteer position sought.
2. An applicant with a sealed record on file with the commissioner of probation may answer 'no record' with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant may answer 'no record' with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services that did not result in a complaint transferred to the superior court for criminal prosecution.
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I certify that the above information is true, complete, and correct to the best of my knowledge. I represent that I have withheld nothing which, if disclosed, would affect this application unfavorably. I understand that any false statement, misrepresentation or omission made by me on my application, resume, or any other materials I have submitted, or during my interviews, can result in denial of my application, or, if I have already been accepted as participant in a Quest when such false statement, misrepresentation or omission is discovered, immediate termination of my participation in the Quest. I understand that, if my participation in the Quest is terminated under such circumstances, I will not be entitled to any refund of the Quest fees that I have paid to United Planet, nor will anyone else who has paid such fees on my behalf be entitled to any refund.
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