Form AF IMT 3569 AF IMT 3569 USAF Museum System Volunteer Application/Registration

USAF HERITAGE SYSTEM VOLUNTEER
APPLICATION/REGISTRATION

DRAFT

DATE

DRAFT

OMB No. 0701-0127
Expires XXXXXXXXX

The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington
Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350
-3100 (0701-0127). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply
with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR RESPONSE TO THE ABOVE ADDRESS.
RETURN COMPLETED APPLICATION TO THE ADDRESS SHOWN ON THE APPLICATION INSTRUCTION SHEET.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 1588, Authority to Accept Certain Voluntary Services; 10 U.S.C. Section 8013, Secretary of the Air Force; 5 U.S.C. 301, Government Organization And Employees;
Department of Defense Instruction1100.21, Voluntary Service in the Department of Defense and Air Force Instruction 84-103, U.S. Air Force Heritage Program.
PURPOSE: To obtain data for use by the volunteer coordinator in selecting and placing volunteers in various USAF Museum activities and to retrieve information for future requirements.
ROUTINE USE: DoD Blanket Routine Uses Apply. http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html.
DISCLOSURE: Voluntary, however, failure to provide the information requested could impede the effectiveness of placing you in the USAF Museum volunteer program.

NAME (Last, First, MI)

HOME PHONE

ADDRESS (Number & Street)

WORK PHONE

CELL PHONE

CITY, STATE, ZIP CODE

EMAIL ADDRESS

DATE OF BIRTH PLACE OF BIRTH

PERSON TO CONTACT IN CASE OF EMERGENCY

RELATIONSHIP

CITIZEN OF

TELEPHONE

EMPLOYER

PREFERRED HOSPITAL

OCCUPATION

EMPLOYED

FULL TIME

PART TIME

TEMPORARILY

Do you have a valid driver's license?
AVAILABILITY:

RETIRED

YES

Weekdays

AM

Weekend

PM

NO

SEEKING EMPLOYMENT

FULLY

Do you have military identification credentials and vehicle pass?
Work shifts per week:

Minimum hours per week:

SCHEDULING LIMITATIONS (Vacations, Seasonal Relocation, TDY's, etc.)

FOREIGN/SIGN LANGUAGE
Read
Write
Speak

WORK INTEREST AREAS
Education

Foundation

Public Affairs

Tours/Guides

Speakers Bureau

Research

Restoration

Collections

Exhibits

Photography/Audiovisual

Mailings

Building Maint/Grounds

Office

Computer

Gift Shop

HOW DID YOU LEARN ABOUT THE MUSEUM PROGRAM?
Visitor

Organizational Referral

AF FORM 3569, 2013XXXX

Personal Referral

Other (Specify):

Previous Editions Obsolete

Other (List)

YES

PARTIALLY
NO

EDUCATION

SPECIAL TRAINING

SPECIAL SKILLS / HOBBIES

CIVILIAN WORK HISTORY

MILITARY SERVICE HISTORY
BRANCH

JOBS/ASSIGNMENTS/SERVICE SCHOOLS/PME

RANK

YEARS/ERA

AIRCRAFT

FEDERAL SERVICE HISTORY
TYPE OF FEDERAL SERVICE

RETIRED

NUMBER OF YEARS
YES (Year)
JOBS PERFORMED

LOCATION

LIST USAF AIRCRAFT YOU ARE/WERE ASSOCIATED WITH AND YOUR AFFILIATION TO THESE AIRCRAFT.

LIST NON-USAF AIRCRAFT YOU ARE/WERE ASSOCIATED WITH AND YOUR AFFILIATION TO THESE AIRCRAFT.

OTHER PRESENT VOLUNTEER JOBS / AGENCIES

OFFICIAL USE ONLY

AF FORM 3569, 2013XXXX

DRAFT

(REVERSE)

NO