Volunteer Application

Age Group *

17 and Under

18 - 24

25 - 39

40 - 59

60+

Gender *

Female

Male

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Home Phone

(###)

###

####

Email *

Are you able to transport residents to appointments or the store? *

(Requires proof of Current Driver's License, Insurance, and Registration)

Yes

Do you have a car? *

Yes

Occupation

Place of Employment

Prior Volunteer Experience

Please list the names and phone numbers of two (2) prior volunteer references:

What do you consider your skills/expertise and talents to be?

What do you consider as your areas of weakness?

Days that you are available *

Check all that apply

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hours of availability *

Check all that apply

9:00 - 12:00

12:00 - 2:00

2:00 - 4:00

4:00 - 7:00

Do you have any physical limitations or medical concerns that we need to know about?

Unable to lift heavy items or sit/stand for long periods of time, etc.

Have you had a TB test in the past 12 months? *

Yes

If yes, please indicate date and result:

If no, are you willing to have a TB test?

Yes

Please answer the following questions:

In volunteering at Elizabeth House, you may work directly or indirectly with the children who live here. For that reason, we would like your cooperation in answering the following questions.

Have you ever been convicted of a crime (not including a minor traffic offense)? *

Yes

If yes, please indicate offense(s) and date(s):

Are you currently using illegal drugs? *

Yes

Have you ever been arrested or convicted of a drug or alcohol-related crime? *

Yes

If yes, please indicate offense(s) and date(s):

Have you ever been arrested for or convicted of a charge of child abuse, of actual or attempted sexual molestation of a minor, or of an offense involving violent behavior? *

Yes

If yes, please indicate offense(s) and date(s)

How did you hear about Elizabeth House? *

Please tell us why you are interested in volunteering at Elizabeth House *

What is most important to you in a volunteer experience? *

Terms & Conditions *

I confirm that all of the above information is correct. I authorize Elizabeth House to investigate all statements contained in this application for the purpose of considering me for a volunteer opportunity. I am offering my services on a volunteer basis and I understand that Elizabeth House can terminate the volunteer relationship at any time. I give Elizabeth House permission to conduct a background check including check of my criminal record and my motor vehicle report (driving record).

I agree

If you are interested in volunteering your time at Elizabeth House, please fill out the volunteer application. Once we have received your application electronically, our volunteer coordinator will contact you about volunteer opportunities that match your skills and interests.

If you are looking for an internship for your college, please go to the Intern/Intern Application under Get Involved and fill out that application instead of this one.

Volunteer Application

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