Volunteer Application

*Name:
*Mailing Address:
*City:
*State: *Zip:
*Phone:
Fax:
*Email:


Work Information:
Employer:
Phone:
Fax:
Email:


Education Information:
Are you a student? Yes No
   If Yes:
      What school do you attend?  
      What grade are you in?  
High School attended:
College attended:
Degrees Earned:


Are you a Christian? Yes No
Where do you attend church?


General Information:
Are you under 18 years of age?   Yes   No
Have you ever used any of the Rescue Mission's programs?
   Yes   No


Prospective volunteers are required to complete the following background discosure information.
Have you been convicted of a crime in the last 7 years?
(A conviction may be relevant if job-related, but does not bar you from our Volunteer Program.)

   Yes   No
Have you been convicted of any crimes against persons?   Yes   No
If yes, please explain:
Have you been found in by a court proceeding to have sexually assaulted, exploited or physically abused any minor?   Yes   No
If yes, please explain:
Have you been found in any disciplinary board decision to have sexually abused or exploited any minor or to have abused any minor?   Yes   No
If yes, please explain:


Please answer the following questions to help us meet not only the needs of the Rescue Mission, but also your needs as volunteer staff:
How did you hear about the Rescue Mission volunteer program?
Have you had any volunteer experience?   Yes   No
If yes, at what agencies and what volunteer services did you perform?
Are you willing to be an "on call" volunteer?
(Only check Yes if you are willing to receive phone calls monthly concerning volunteer opportunities)


   Yes   No
How often will you be available to volunteer? Please mark one of the following:
Once a week
Thanksgiving
 Once a month
Christmas
 Number of Hours
Other


Which volunteer opportunities are you interested in? Please mark one or more of the following:
Annual Thanksgiving Banquet
Cornerstone Thrift Store
Cornerstone Women & Childrens Home
List three references: One from your pastor, co-worker, and friend
Name: Phone #:
Name: Phone #:
Name: Phone #:


Person to be contacted in case of emergency:
Name: Relationship:
Address: Phone:
City:
State: Zip:




*I certify that the statements and representations made in this volunteer application are true and correct and have been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest.
*I hereby release the Rescue Mission and its representatives from liability and all other persons, corporations or organizations for furnishing such information.


Agreement
I understand that I will not be paid for my services as a volunteer. I agree to abide by the policies and procedures of the agency.