Volunteer Application

Qualified volunteer applicants are considered without regard to race, color, religion, sex, national origin, age, marital status or presence of the non-job related medical condition or disability.

Personal Information:
First Name Last Name
Nick Name    
Address 1 Address 2
City State
Zip Code    
Home Phone Other Phone
Email Address*    
In Case Of Emergency, Notify:
First/Last Name    
Phone    
Relationship    
Experience:

Education:
Name of School 1 Did You Graduate
Major    
Name of School 2 Did You Graduate
Major    
Work Experience:
Employer 1    
Position    
When?    
Employer 2    
Position    
When?    
Previous Volunteer Experience:
Agency Name 1    
City State
When?    
Agency Name 2    
City State
When?    
References:
Please provide two (2) Academic, Professional or Volunteer References who are not related to you: If you are a Junior Volunteer, be sure one of your References is a Teacher.
Reference Name 1    
Relationship    
Address    
City State
Zip Code    
Home Phone Work Phone
Reference Name 2    
Relationship    
Address    
City State
Zip Code    
Home Phone Work Phone
Questionnaire:
How did you learn about the volunteer opportunities at Elim Park?
List special skills or interests as they apply to volunteer position:
Please indicate the areas/departments that you may be interested in:
Do you have any limitations for which we need to make adaptations?
If yes, explain:
Have you ever been convicted of a felony or misdemeanor?
If yes, explain:

Availability:
Please list the times you are available to volunteer:

Sun Start Sun End
Mon Start Mon End
Tues Start Tues End
Wed Start Wed End
Thurs Start Thurs End
Fri Start Fri End
Sat Start Sat End
Total number of hours you would like to volunteer each week?

Authorization for Participation By Parent (for Junior Volunteers Only)

I grant permission for
to participate in the Junior Volunteer program at Elim Park Baptist Home, Inc.


Parent or Legal Guardian Type name here to agree

Date

Applicant's Statement

I authorize the Volunteer Office to contact the references provided by me to obtain the information pertinent to my responsibilities as a volunteer at Elim Park Baptist Home, Inc.

I agree to abide by the policies and regulations of the Home and Volunteer Services Department and to participate in orientation and training required by the Home.

I certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that if I am accepted into the Volunteer Service program, false statements may result in my dismissal.

I understand that I am expected to inform the Department of Volunteer Services of any significant change in my health status that would have a negatively impact on my ability to perform the tasks to which I am assigned.

Applicant Type name here to agree

Date
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