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:

City:

State:

Zip:

Home Phone:

203-123-4567

Other Phone:

203-123-4567

Email address:

In Case of Emergency, Notify:

First and Last Name:

Phone:

203-123-4567

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.

Name 1:

Relationship:

Address:

City:

State:

Zip:

Home Phone:

203-123-4567

Work Phone:

203-123-4567

Name 2:

Relationship:

Address:

City:

State:

Zip:

Home Phone:

203-123-4567

Work Phone:

203-123-4567

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 times you are available to volunteer:
	Sun	Mon	Tue	Wed	Thu	Fri	Sat
Start:
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 MM/DD/YYYY


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 MM/DD/YYYY